birth is a life changing event and the care given to women has the potential to affect them both physically and emotionally in the short and longer term ( royal college of obstetricians and gynecologists [ rcog ] ) . the overall objective taking care of women during childbirth is creating a positive experience for a woman and her family while preserving their physical and psychological health , preventing of morbidity and reaction to the emergency situations . the maternal expectations during labor play an important role in specified a woman 's response to her childbirth experience . identifying women 's expectations , wishes , needs and fears empower the health care providers to achieve toward a common target of a positive birth experience . every year , more than 1 million women give birth in iran that 90% of them receive maternity care in the hospital . despite many modifications in the iranian health care system in the recent decades , there is still more space for enhance in the quality of maternity care . evidence - based practice ( ebp ) is simply the integration of the best available research - based clinical evidence , clinical expertise , and patient needs , values and preferences to develop a system of quality care . although ebp detected as necessary for quality care in developed countries , it is often based on research and clinical evidence and less attention has been paid to the needs and preferences of the parturient women . there is often a gap between what women expect to receive from their maternity care and the level of services that provided by healthcare professionals . furthermore identifying parturient needs , values and preferences requires for quality improvements of care during normal labor and delivery . in this study , we aimed to explore women needs and expectations during intrapartum care . this qualitative study was a part of a comprehensive study which aimed to explore parturient needs , values and preferences during normal labor and delivery . we conducted a descriptive exploratory qualitative study in three hospitals of alzahra , shahid beheshti and ashrafi esfahani which all be affiliated to the isfahan university of medical sciences . participants were recruited to low - risk women after they had given birth , but a few hours before they were discharged from hospital . in purposive sampling , the researcher is seeking people who have rich experiences of the phenomenon and possess ability and willingness to express them . the inclusion criteria were as follows : parturient mothers of 1845 years of age with a low - risk and full - term pregnancy , having a healthy child , no history of depression before or after giving birth , speaking in persian and good cooperation during interviews . this study was approved by the ethics committee of the isfahan university of medical science ( no : 391206 ) and tenets of the declaration of helsinki was followed . the aim of the study was explained to the participants , and their written informed consent was obtained . furthermore , it was explained that the participants could withdraw from the study at any time . the data were collected using semi - structured in - depth interviews , informal observations and field notes during april - july 2013 . the participants were asked to talk about their preferences and needs during labor and childbirth . first , interview was started by a general question : what were your needs and expectations during childbirth ? field notes were recorded by the researcher in the hospital ward and performed in different shifts . in general , data saturation occurred when no more codes or themes could be emerged in the last two interviews . data analysis was undertaken simultaneously with data collection in order to identify new and important issues that could be addressed during the subsequent interviews . first , after transcribing each interview , the researcher reviewed the text several times until a general impression is received . third , each meaning unit was summarized to a  condensed meaning unit  and then primary codes were obtained . similar subcategories were grouped into main categories that are presented as findings in this paper . eventually , we were determined themes as the expression of the hidden content of the text in the fifth stage . the findings contain direct quotes from participants , and the narrations are reported as they were spoken by participants without editing the grammar to avoid losing meaning . to enhance rigor and trustworthiness of the study , these measures were considered : prolonged engagement with participants in data collection , searching negative cases , member check ( confirming samples of coded data by participants ) , and peer debriefing to enhance the credibility through confirming samples of coded data by experienced qualitative researchers . data analysis was undertaken simultaneously with data collection in order to identify new and important issues that could be addressed during the subsequent interviews . first , after transcribing each interview , the researcher reviewed the text several times until a general impression is received . third , each meaning unit was summarized to a  condensed meaning unit  and then primary codes were obtained . similar subcategories were grouped into main categories that are presented as findings in this paper . eventually , we were determined themes as the expression of the hidden content of the text in the fifth stage . the findings contain direct quotes from participants , and the narrations are reported as they were spoken by participants without editing the grammar to avoid losing meaning . to enhance rigor and trustworthiness of the study , these measures were considered : prolonged engagement with participants in data collection , searching negative cases , member check ( confirming samples of coded data by participants ) , and peer debriefing to enhance the credibility through confirming samples of coded data by experienced qualitative researchers . the data were obtained from interviews with 24 participants . also 16 field notes to become immersed in the data . 24 subcategories and 7 main categories including physiological needs , psychological needs , informational needs , social and relational needs , esteem needs , security needs and medical needs emerged [ table 2 ] . all of key finding in these data relates to the theme , named  sense of control and empowerment in childbirth .  below , the meaning of each category is presented by using the participants direct quotations . characteristics of participants parturient needs and preferences during normal labor and delivery from the iranian women 's perspectives one of the extracted categories from the data was physiological needs . it consisted of four sub categories : nutritional needs , physical environmental conditions , individual and hygienic needs , provision of physical comfort and ensure of privacy . some women commented that they felt out of energy , and they were worried where they would find their strength to be able to give birth in that condition . ward routines , such as control room temperature , control noise , dim lights , control odors , were something that women found difficult to comprehend . i was annoyed once the lights of ward being switched on early in the morning and kept on until late at night ( p1 , 24 years old , g1 ) . respondents reported that clean sleeping quarters were an important need for most of them . one of the participants expressed that :  because they are so busy you ca nt every time you need to change the sheet or once you say can you get me another sheet you do nt like that they buzzing  ( p16 , 34 years old , g3 ) . participants also spoke about the need for physical comfort including ambulation , walking , and changing positions . i was tired from uncomfortable lying down during labor ; i loved the walk , but midwife told me that i should lie down  ( p7 , 41 years old , g4 ) . the subcategories of this category were empathy and advocacy , constant emotional support and assure and encouragement . the participants expected the midwives to show empathy and advocacy , and to give them constant emotional support . the empathy and kindness of midwife really relaxed me ; when she was good - tempered with me , i felt that i was in control some of the women expressed they were emotionally comforted by receiving verbal encouragement during their labor and birth . one of the women reported :  when the doctor encouraged me during labor pain , i felt that i could handle more my pain the subcategories of this category were  inform of women with the ward environment , acquaint of women about labor process ,   informing women of the plan of care and procedures  and  basic practical aspects of care for themselves and their baby . familiarity with the labor environment was an essential requirement for many women at the time of admission for childbirth . a woman explained :  i expected to be informed of basic things , like to be shown around and particularly about things that i need to use in the ward . ( p20 , 19 years old , g1 ) . another information need of women was to get familiar with the labor process . it was observed that the laboring women did not have the basic knowledge about labor and delivery process . the participants expected the midwives to explain their actions and findings , and to guide and encourage them on what to do . an action  and we do nt know how to do it , and they say that you do nt understand . therefore , they should be taught and clearly explained for our  ( p5 , 37 years old , g3 ) . many women wanted information that would help them to develop their confidence in necessary practical aspects of care for themselves and their baby . midwives explained anything that i needed to take care of myself and my baby ; when they explained things , i got a great sense of quietness it consisted of two sub categories : communication to health care professionals ( physician , midwife , nurse ) and constant presence of familiar attendant ( partner , relative of family , doula ) . they expected , the midwives to give the mothers timely attention and welcome them warmly and listen patiently to their conversations at the time of admission . one of the participants said :  firstly , i would expect them to welcome me with amiability and ask what my problems are me and what i am there for . i would like explain all things about my condition for the physician or midwife , and she patiently listens to my talks there were some expression made about call not being answered , or that they were slow to answer when women called for them . the physician promised me that herself perform my delivery ; she called by telephoning and arriving just when i delivered . the presence and support of a partner during labor and childbirth seemed to be of paramount importance for some of the women . some of the women interviewed believed to the present of partner in the labor ward while some preferred that partner not present in labor and delivery room . one woman said :  if possible , allowing my husband to support me physically and emotionally is the best thing that could happen to me . the presence of the family relative or a friend was important to a woman in labor . the subcategories of this category were sense of valued ( conveying respect ) , confidence ( establish trusting early ) , competence ( self - efficacy ) , participation in decision and feel involved in the care . the participants emphasized the need for conveying respect and established trusting early of health care providers . a participant said :  i feel like a lucky person to have a doctor that i trust as much as i do . i am very lucky to have found her and have her involved in very important decision in my life the women described that they felt calm when they were well informed about their ability to give birth . one of the mother said :  the midwife explained what was going on as i was in labor , and this meant i felt i was in control . because i was sure that i can my expectations upon myself to have a labor and deliver this baby , you know , feeling very empowered . the participants commented on the importance of their partner and themselves being involved in deciding on various aspects of care . one of the participants said :  i would nt have thought i could have done this ( birthed ) , but after being involved in deciding for care of myself , i knew i could do it and i just found it very good to be with myself during labor . security need was a major category that was derived from the experiences of laboring women during labor and delivery process . the subcategories of this category were domination on fear of losing the baby and anxiety about his / her health , domination on fear of childbirth , domination on , domination on fear of encounter the unknown or fear of dying and assure of professional expertise of doctor or midwife . the loss of a child has to be the hardest pain ever to go through i do nt deny all risks as may be something happen during the childbirth but i wished to have a comfortable and secure childbirth ; i also was very scared that a perineal rupture may occur i was scared that something unexpected happens and that a state of emergency may occur that might influence my capacity to manage emotionally . the main subcategories of this category were pain relief and prevention of unnecessary intervention during labor ( for example : frequently use of urinary catheter and vaginal examination ; routine use of episiotomy and enema ) . however , i want the childbirth to be as natural as possible  ( p8 , 24 years old , g1 ) . many women believe they re likely to go through labor and give birth without medical intervention . the women described that procedures such as  use of a urinary catheter  were undertaken frequently and routine . one woman said :  the use of urinary catheters for me was really hurts , i would prefer go to the bathroom  ( p22 , 40 years old , g3 ) . the women also described that procedures such as  vaginal examination  were undertaken frequently and unnecessary . i had a horrendous fear of repeat vaginal examination during childbirth ; i think most examination for me was really unnecessary it consisted of four sub categories : nutritional needs , physical environmental conditions , individual and hygienic needs , provision of physical comfort and ensure of privacy . women have expressed their desire to eat and or drink through labor . some women commented that they felt out of energy , and they were worried where they would find their strength to be able to give birth in that condition . ward routines , such as control room temperature , control noise , dim lights , control odors , were something that women found difficult to comprehend . i was annoyed once the lights of ward being switched on early in the morning and kept on until late at night one of the participants expressed that :  because they are so busy you ca nt every time you need to change the sheet or once you say can you get me another sheet you do nt like that they buzzing  ( p16 , 34 years old , g3 ) . participants also spoke about the need for physical comfort including ambulation , walking , and changing positions . i was tired from uncomfortable lying down during labor ; i loved the walk , but midwife told me that i should lie down  ( p7 , 41 years old , g4 ) . the subcategories of this category were empathy and advocacy , constant emotional support and assure and encouragement . the participants expected the midwives to show empathy and advocacy , and to give them constant emotional support . the empathy and kindness of midwife really relaxed me ; when she was good - tempered with me , i felt that i was in control ( p9 , 28 years old , g1 ) . some of the women expressed they were emotionally comforted by receiving verbal encouragement during their labor and birth . one of the women reported :  when the doctor encouraged me during labor pain , i felt that i could handle more my pain the subcategories of this category were  inform of women with the ward environment , acquaint of women about labor process ,   informing women of the plan of care and procedures  and  basic practical aspects of care for themselves and their baby . familiarity with the labor environment was an essential requirement for many women at the time of admission for childbirth . a woman explained :  i expected to be informed of basic things , like to be shown around and particularly about things that i need to use in the ward . it was observed that the laboring women did not have the basic knowledge about labor and delivery process . the participants expected the midwives to explain their actions and findings , and to guide and encourage them on what to do . an action  and we do nt know how to do it , and they say that you do nt understand . therefore , they should be taught and clearly explained for our  ( p5 , 37 years old , g3 ) . many women wanted information that would help them to develop their confidence in necessary practical aspects of care for themselves and their baby . midwives explained anything that i needed to take care of myself and my baby ; when they explained things , i got a great sense of quietness it consisted of two sub categories : communication to health care professionals ( physician , midwife , nurse ) and constant presence of familiar attendant ( partner , relative of family , doula ) . they expected , the midwives to give the mothers timely attention and welcome them warmly and listen patiently to their conversations at the time of admission . one of the participants said :  firstly , i would expect them to welcome me with amiability and ask what my problems are me and what i am there for . i would like explain all things about my condition for the physician or midwife , and she patiently listens to my talks  ( p12 , 26 years old , g1 ) . there were some expression made about call not being answered , or that they were slow to answer when women called for them . the physician promised me that herself perform my delivery ; she called by telephoning and arriving just when i delivered . the presence and support of a partner during labor and childbirth seemed to be of paramount importance for some of the women . some of the women interviewed believed to the present of partner in the labor ward while some preferred that partner not present in labor and delivery room . one woman said :  if possible , allowing my husband to support me physically and emotionally is the best thing that could happen to me . ( p8 , 24 years old , g1 ) . the presence of the family relative or a friend was important to a woman in labor . the subcategories of this category were sense of valued ( conveying respect ) , confidence ( establish trusting early ) , competence ( self - efficacy ) , participation in decision and feel involved in the care . the participants emphasized the need for conveying respect and established trusting early of health care providers . a participant said :  i feel like a lucky person to have a doctor that i trust as much as i do . i am very lucky to have found her and have her involved in very important decision in my life the women described that they felt calm when they were well informed about their ability to give birth . one of the mother said :  the midwife explained what was going on as i was in labor , and this meant i felt i was in control . because i was sure that i can my expectations upon myself to have a labor and deliver this baby , you know , feeling very empowered . the participants commented on the importance of their partner and themselves being involved in deciding on various aspects of care . one of the participants said :  i would nt have thought i could have done this ( birthed ) , but after being involved in deciding for care of myself , i knew i could do it and i just found it very good to be with myself during labor . security need was a major category that was derived from the experiences of laboring women during labor and delivery process . the subcategories of this category were domination on fear of losing the baby and anxiety about his / her health , domination on fear of childbirth , domination on , domination on fear of encounter the unknown or fear of dying and assure of professional expertise of doctor or midwife . the loss of a child has to be the hardest pain ever to go through i do nt deny all risks as may be something happen during the childbirth but i wished to have a comfortable and secure childbirth ; i also was very scared that a perineal rupture may occur i was scared that something unexpected happens and that a state of emergency may occur that might influence my capacity to manage emotionally . the main subcategories of this category were pain relief and prevention of unnecessary intervention during labor ( for example : frequently use of urinary catheter and vaginal examination ; routine use of episiotomy and enema ) . however , i want the childbirth to be as natural as possible  ( p8 , 24 years old , g1 ) . many women believe they re likely to go through labor and give birth without medical intervention . the women described that procedures such as  use of a urinary catheter  were undertaken frequently and routine . one woman said :  the use of urinary catheters for me was really hurts , i would prefer go to the bathroom  ( p22 , 40 years old , g3 ) . the women also described that procedures such as  vaginal examination  were undertaken frequently and unnecessary . i had a horrendous fear of repeat vaginal examination during childbirth ; i think most examination for me was really unnecessary to our knowledge , this is the first qualitative study that explored and discovered parturient needs and preferences during labor from the iranian women 's perspective . as presented in the results , seven main categories were relates to women 's needs , values and preferences during normal labor and delivery . all of key needs in these data relates to a central need , named  sense of control and empowerment in childbirth .  the findings of the current study expressed that intervening to promote physiological needs can positively influenced on the women 's sense of control and empowers during birthing . this study demonstrated that some of women were disappointed of restriction of eating and drinking during labor . the world health organization recommends that healthcare providers should not admix in restriction of low - risk women for eating and drinking during labor . since the evidence shows no benefits or harms , there is no rationalization for the constraint of fluids and food in labor for women when no risk factors are apparent . balancing room light and temperature while decreasing annoying noises and use of music will help to physical comfort . the participants believed that the promotion of comfort was an essential need for them during labor . intervening to promote the comfort of laboring women can empower these women during childbirth . increasing comfort can decrease labor pain , need for medical interventions and costs . the participants expected the midwives to show empathy , advocacy , interest and constant emotional and moral support . they believed women who felt that their midwife had supported them had a more sense of control than those who did not feel that support from their midwife . based on results of a cochran systematic review :  supportive care during labor may enhance physiologic labor processes as well as women 's feelings of control and competence , and thus reduce the need for obstetric intervention . women who received continuous labor support were more likely to give birth spontaneously and give birth with neither caesarean nor vacuum nor forceps . in addition , women were less likely to use pain medications , were more likely to be satisfied , and had slightly shorter labors . the participants of this study believed that besides to midwives , nonmedical people such as a husband , family members ( mother , sister etc . ) this study found that childbirth information received by mothers during antenatal period influences their sense of control and empowerment during labor and delivery . women reported greatest interest in topics such as familiar with the ward environment , familiar with the labor process , informing of the plan of care and procedures and care of themselves and their baby . malata reported that 1 time mothers are not satisfied with the amount of labor and childbirth information given in the birth centers . blackford et al . reported that most women receive inappropriate and inadequate information about childbirth , and there is a need to discover women 's needs to ensure the offering of appropriate and adequate informational . also , malata and chirwa found that the mothers did not satisfy of childbirth information that received during the antenatal period . childbirth information received by mothers during the antenatal period affect their satisfaction of the care during intrapartum care . it is important for the midwives to know the kind of information that satisfies their clients . in this study also , presence of the physician , midwives or one of family relative such as her husband , partner , mother or friend was highly valued by women . based on clinical guideline published by the rcog :  developing a rapport , trust and effective communication between healthcare providers and women is important to a woman 's positive childbirth experience . the participants emphasized that presence of doctor and midwife in the labor and delivery room was an important component of women 's needs during childbirth . the presence of a doctor in a labor ward may decrease the anxiety and fear which parturient women may feel . it is mostly caused by to cultural and social differences . in iranian culture , mothers perform a vital role for care during labor and delivery . the world health organization recommended that ,  the parturient woman should be accompanied by people with whom she feels safe and trust ; possibly doula , midwife , her husband or a friend . the participants emphasized that sense of valued ( conveying respect ) , confidence ( establish trusting early ) and competence ( self - efficacy ) are important aspects for women during care . the mothers also pointed out that they wanted to participate in decision making and being involved in various aspects of care . lowe reported that women with low self - esteem do nt have the same confidence in their internal resources and also have undeveloped adaptation mechanisms . she believed that women who indicate greater confidence in their strength to confront with labor also express feeling less pain during labor . she also finds that women with low self - efficacy experience more fear of childbirth as well as fear of losing control during labor . also , results of childbirth investigation showed that the self - efficacy influenced woman 's compatibility and experiences of childbirth . based on clinical guideline published by rcog :  all women in labor should be treated with respect and should be in control of and involved in what is happening to them , and the way in which care is given .  another need that emphasized in participants interviews were the need to safety and security . all participants stated that once women of their own safety and their baby were assured , this issue can lead to their feeling of control and empowerment . fear of childbirth and low self - confidence affects on women ability for give birth . in a study , adams et al . found that fear of childbirth increased the duration of labor in women . also , fear of childbirth often leads to request for an elective cesarean section . in pregnant women with fear of childbirth , psycho education , focuses on enabling coping strategies and support increases rates of spontaneous vaginal delivery , reduces caesarean rates and improves delivery experience . the participants believed that a professional expertise of doctor or midwife and presence of their in the labor room seemed to be supportive in creating a sense of security for laboring women . in this study , the most important medical needs of women were pain relief and prevention of unnecessary interventions . delivery pain is one of the most severe pains that women experience during their life . leap and anderson reported that most women are afraid of labor pain . in our study , the participants expected labor to be painless . in a study of nilsson et al . , the mothers stated that the reduction of pain could influence the sense of control on positively . in this study , most women believed that they received unnecessary intervention during normal labor and delivery . however , some of women were considered it as a positive factor to their experience especially when abnormal labor occurred . yet women and their partners are often unaware that many routine interventions can lead to a cascade of unplanned experiences and unwanted side effects . decisions about interventions should incorporate the woman 's personal values and preferences and should be made only after she has had enough information to make an informed choice in partnership with her care team .  for example , based on the best evidence , vaginal examination during labor should be performed only when necessary , and if applicable , by the same provider . providers should protect for women 's right to information , respect , dignity and privacy . in brief , our findings highlighted many aspects of women 's expectations related to childbirth and gave a new insight for midwifes and physicians to help these women have a better experience related to childbirth . therefore , we can not generalize the findings to other qualitative studies and to all the women undergoing normal labor and delivery . one of the components for both evidence - based care and woman - centered care is women preferences . evidence - based care is an important instrument for improving the quality of maternity care . woman - centered means that care respects the values , culture , choices , and preferences of the woman and her family , within the context of promoting optimal health outcomes . the attempt in order to incorporate women expectations and preferences into midwifery care needs to a multifaceted intervention ; multifold levels of health care professionals to organizations and health systems must be targeted . the finding of this study indicated that there is a need for empowering health care professionals and iranian women for increased knowledge about obstetric care based on the needs of women in their care . if midwives to explore and discover the expectation and needs of women in their care so that sensible expectations can be encouraged and then , hopefully , complied ; this issue could lead to women 's empowerment for normal vaginal delivery .
background : pregnancy and birth are unique processes for women . women and families hold different expectation during childbearing based on their knowledge , experiences , belief systems , culture , and social and family backgrounds . these differences should be understood and respected , and care is adapted and organized to meet the individualized needs of women and families . 
 the purpose of this study was to explore iranian parturient needs , values and preferences during normal labor and delivery.materials and methods : an exploratory qualitative study was used . 
 twenty - four parturient women from three governmental medical training centers in isfahan , iran were recruited using purposive sampling . 
 participants were recruited to low - risk women after they had given birth , but before they were discharged from hospital . 
 data were collected through semi - structured in - depth interviews , informal observations and field notes . 
 interviews were transcribed verbatim and analyzed by the conventional content analysis according to graneheim and lundman approach.results:women's needs and expectations fell into seven main categories : physiological , psychological , informational , social and relational , esteem , security and medical needs . 
 all of the key needs in these data relates to a fundamental need , named  sense of control and empowerment in childbirth.conclusion:knowing a woman 's needs , values , preferences and expectations during normal labor and delivery assists healthcare professionals especially midwives in providing high - quality care to parturient women .