Assessing the factors of mother s dissatisfaction with labor and delivery care procedure in educational and non-educational hospitals in Tabriz

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Pelagia Research Library European Journal of Experimental Biology, 2013, 3(6):132-139

ISSN: 2248 –9215 CODEN (USA): EJEBAU

Assessing the factors of mother’s dissatisfaction with labor and delivery care procedure in educational and non-educational hospitals in Tabriz Somayyeh Naghizadeh1, Azita Fathnejad Kazemi1, Mehdi Ebrahimpour2 and Faride Eghdampour1* 1

Department of Midwifery, Tabriz Branch, Islamic Azad University, Tabriz, Iran 2 Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Iran

_____________________________________________________________________________________________ ABSTRACT This descriptive comparative study is done on 270 childbirth mothers who were admitted in Alzahra, Taleghani and 29 Bahman hospitals in Tabriz. For data collection, a questionnaire was used to measure the factors of mothers’ dissatisfaction with physical cares, training and information provided to the mothers, ethical and emotional supports during labor and delivery. the most important factors of dissatisfaction during labor include lack of introducing different caretakers and available possibilities and manner of using them, lack of doing actions for reducing the childbirth pain, lack of explaining about uterine contractions and progress of delivery. The mothers’ dissatisfaction during delivery was more than labor. The most important factors of dissatisfaction in delivery were related to lack of soothing and hugging the mother during labor, not being allowed to choose the midwife among different caretakers and not gripping the mother’s hand during delivery. The mothers’ dissatisfaction with labor and delivery care and supports was significantly different among educational and non-educational hospitals (p≤0.05). Keywords: Dissatisfaction, Care, Support, Labor, Delivery _____________________________________________________________________________________________ INTRODUCTION Delivery is a very important physiological event in a woman's life with deep physical, psychological and emotional effects on them. This phenomenon is associated with pain, psychological strain, vulnerability, probable physical effects and death in some rare cases (1). Taking care of mother in delivery with no side effects is the responsibility of a midwife. She is the only person who is skillful in this regard and has the responsibility of looking after mothers and babies. The quality of midwifery care is one of the issues, which has major effects on the results of delivery. The performance and activities of the midwife in this critical situation might not only have different results ranging from life to death and health to physical damage but also they might considerably affect the psychological and emotional health of the mother and the baby(2). Patient satisfaction is a concept that is highly important in medical care (3, 4). Patient satisfaction refers to a patient's satisfaction with the health care provided (5). Harvey (2002, as cited in Donabedian) believes that "satisfaction with health care is an important criterion and variable in assessing the quality of medical care" (6). Patients' satisfaction with the caring services is important since the satisfied patients show different reactions in comparison to the unsatisfied ones, and the satisfied patients continue the treatment, follow it and invite the others to use them. Therefore, the satisfied patients not only do not stop using nursing services but they also tend to use it growingly (5). Moreover, Chunuan (2002) claims that if a woman feels dissatisfied with her delivery experience, she can hardly communicate with her baby, and a positive labor experience might affect her next delivery and her opinion about herself as a mother (7). Mackey and Stepans (2006) in their study entitled, “Women’s evaluation of

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Faride Eghdampour et al Euro. J. Exp. Bio., 2013, 3(6):132-139 _____________________________________________________________________________ child labor and delivery nurses" indicated that 90 percent of the women labeled their labor and delivery desirable and 10 percent considered it to be undesirable. They considered the nurses performance to be desirable in the following aspects: participation (80%), reception (76%), giving information (76%), encouragement (65%), presence (53%), capability and merit (7%) (8). The recent studies in middle east and developing countries confirmed the usefulness of women's report in determining the quality of caring services. In Lebanon, they showed that women who had complete confidence in their doctors and rarely asked questions, considered many routine processes to be useful, even at times when the researchers considered them to be unnecessary (9). In a study by Ordibeheshti (1998), the mothers’ expectations from caretakers were estimated in 20% of cases, were approximately estimated in 23.8% and were not estimated in 56.2% (10). The study done by Mirmolaei & et.al (2008) in Tehran University of Medical Sciences showed that most of the mothers were fully satisfied with the manner of receiving three kinds of support (informational, emotional and physical) (11). Since it is not possible to improve the quality of patient care services without attending to the patients' ideas and expectations and considering the fact that midwives are among the main members of the primary health care team and have major roles in pre-labor and postpartum care, they need to be aware of the factors affecting the patients' satisfaction (11). Due to the lack of research on determining the factors of mothers’ dissatisfaction with labor and delivery care and supports, there needs to do a research in this area, so we decided to do a study entitled as assessing the factors of mother’s dissatisfaction with labor and delivery care and supports in educational and non-educational hospitals in Tabriz. So, the weak points in care programs will be explored based on the results and therefore we are reached on one of the important aims of health care systems, that is promoting mothers’ health and supplying physical, mental and social welfare by referring the study results to the authorities and preparing suitable strategic policies. MATERIALS AND METHODS The present study is a cross-sectional descriptive analytical research that was conducted in the educational hospitals of Al-Zahraa (S) and Taleqani and the non-educational hospital of 29 Bahman in Tabriz. To calculate the sample size, ratio formula was used:

α   z1 _  P(1 _ p ) 2  n= 2 2

d

At a probability level of 95 %, the sample size was estimated to be 270. The sampling procedure in this study was based on quota sampling. Since the number of child deliveries in Tabriz hospitals was different, the statistics of vaginal delivery from each hospital was obtained, so in the first six months of 2009, the number of natural delivery in Al-Zahraa (S), Taleqani and 29 Bahman hospitals was respectively 2849, 2184 and 1698. In proportion to the number of birth deliveries in each hospital, the intact sample of the qualified mothers was selected, and respectively 114, 86 and 70 mothers who had referred to Alzahraa (S), Taleqani and 29 Bahman hospitals were selected. The instruments of data collection in this study included a questionnaire which was prepared by the Newcastle Satisfaction with Nursing Scale (NSNS) (5), Sylheti questionnaire (12), Labor/delivery evaluation scale (13), Patient Satisfaction Questionnaire (PSQ), Patient Satisfaction with Health Care Questionnaire (PSHCSQ) (7), Satisfaction with Intrapartum care, Satisfaction with Antenatal care Scale, Satisfaction with Postnatal care scale (14) and the questionnaires from the theses of Ordibeheshti (10) and Mirmolaei (15). The first part of this questionnaire is about personal-social features and the history of previous and present deliveries, and the second, third and fourth parts of the questionnaire are about the factors of mothers’ dissatisfaction with physical cares, training and information provided to the mothers, ethical and emotional supports. The physical part included 23 questions (12 questions related to labor and 11 questions related to delivery), the information part included 23 questions (14 questions related to labor and 9 questions related to delivery), the ethical part included 17 questions (9 questions related to labor and 8 questions related to delivery) and the emotional part included 20 questions (9 questions related to labor and 11 questions related to delivery). The questions were arranged as unsatisfied, no comment and satisfied using Likert three-point scale. In measuring the factors of mothers’ dissatisfaction, the unsatisfied ones were assessed to specify the factors of mothers’ dissatisfaction with labor and delivery care and supports respectively. The validity of the questionnaire was established by content validity procedures. To ensure the content validity of the questionnaire, it was given to 10 members of academic staff at Tabriz University of Medical Sciences. In order to determine the reliability, the questionnaire was completed by 30 mothers. The reliability in Cronbach's alpha was

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Faride Eghdampour et al Euro. J. Exp. Bio., 2013, 3(6):132-139 _____________________________________________________________________________ determined to be 0.829. To start the research, having obtained the needed reference letter from the faculty and having introduced himself to the hospital authorities, the researcher went to postpartum section. After the mother's state stabilized, the researcher asked permission from her for examining her file in terms of meeting research conditions including being in the age range of 18 to 35, no background of physical and psychological illnesses (according to the mothers' self-report), the mother's willingness to take part in the research, no indication of cesarean section, term pregnancy, having trouble-free pregnancy and being hospitalized 2 hours before the delivery. If the patient met the needed qualifications, the questionnaire was completed. Before the study, the necessary permits were obtained from the research committee of Tabriz University of Medical Sciences. Moreover, all cases under study were informed of the purpose of the study, methodology, optional nature of participation in the study and the confidentiality of the information. They were also informed that they can leave the study whenever they wanted. To analyze the data, SPSS software was used. To examine the factors of mothers’ dissatisfaction, descriptive statistics was used. To study the relationship between personal-social characteristics and midwives particulars with the factors of mothers’ dissatisfaction, ANOVA, correlation tests, and independent T-tests were used. Finally, to compare the factors of dissatisfaction with educational and non-educational hospitals, independent samples T-test was used. RESULTS The average age of the mothers was 24.96±4.791. Most of the women (46.7 %) were between the age range of 18 to 23. Seven percent of the mothers had university level education, 35.2 % had senior high school level education, 30.7 % had primary schooling, 22.2 % had junior high school education and 13 people (4.8%) were uneducated. Most of the subjects (80%) were housewives, 4.8 percent were employed out of home and 15.2 percent were self-employed home businesses. The average number of surviving children per families under study was 1.49±0.803; the average number of dead children per family was 0.04±0.208, and the average number of abortions was 0.15±0414. The majority of the family units under study were nulliparous. Among the mothers 245 cases (90.7 %) had no pain or problem during the delivery and pregnancy, and 249 cases (92.2%) had previous information or familiarity with the delivery. The main source of information about mothers was the health personnel (25.6 %), and the least important source of information (2.2 %) was through the people with whom the patients were in contact. There was statistically significant relationship between personal-social characteristics and midwifery of the research units in two kinds of educational and non-educational hospitals (P≥0. 05). Studying the factors of dissatisfaction with physical labor cares were done on 12 factors; the most dissatisfaction with educational and non-educational hospitals were related to lack of doing actions for reducing the childbirth pain such as back massage, using drugs and etc. (Table No. 1). Table 1: Causes of maternal dissatisfaction with physical labor cares Dissatisfaction with physical labor cares Did actions to reduce childbirth pain (For example, back massage, using drugs and etc.) Allowed you to walk in the labor room whenever you want trying the noise in the labor room to be appropriate changed your Clothing and bed linen when wet and dirty. satisfy your needs In times of hunger and thirst or they had a convincing answer. Were trying to make the light, temperature and air flow in the labor room appropriate . refused to examine repeatedly. trying to provide the equipments You needed. Helped you to be in the correct position on the examination table or getting up from it. advised you In times of need to urinate and defecate. Controled your Vital signs (blood pressure, respiration, temperature and pulse rate). monitor The fetal heart rate. P-value=0/0001

educational N(%) 168(84) 97(48.5) 88(44) 52(26) 45(22.5) 44(22) 43(21.5) 38(19) 35(17.5) 30(15) 12(6) 2(1)

non-educational N(%) 57(81.4) 7(10) 29(41.4) 12(17.1) 5(7.1) 6(8.5) 3(4.3) 5(7.1) 11(15.7) 5(7.1) 3(4.3) 1(1.4)

Studying the factors of dissatisfaction with physical cares in delivery room were done on 11 factors; the most dissatisfaction in educational hospitals was related to the pressure on the abdomen during childbirth and in noneducational hospitals was related to lack of giving blanket during postpartum shivering (Table No. 2).

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Faride Eghdampour et al Euro. J. Exp. Bio., 2013, 3(6):132-139 _____________________________________________________________________________ Table 2: Causes of maternal dissatisfaction with physical cares in delivery Dissatisfaction with physical cares in delivery avoid pressing on the abdomen during childbirth if you do not wish. helped you in Transferring onto the delivery bed and coming down from it. helped you during postpartum shivering and gave you a blanket. After delivery, put you in a comfortable position. Did health Care immediately after birth. Before perineal cutting and repair used anesthesia. Were trying to light, temperature and air flow in the delivery room to be appropriate. The bleeding was controlled and did the necessary steps to fix the problem. If the delivery was problematic for any reason, number of actions were taken to address due to solve the problem. If there was something wrong, like when the baby required resuscitation, efforts were taken to address due to solve the problem. Did the postdelivery care for your baby. P-value=0/004

educational N(%) 51(25.5) 42(21) 35(17.5) 33(16.5) 23(11.5) 21(10.5) 17(8.5) 7(3.5) 6(3) 4(2) 1(0.5)

non-educational N(%) 6(8.6) 2(2.9) 26(37.1) 4(5.9) 0(0) 5(7.1) 3(4.3) 3(4.3) 1(1.4) 0(0) 0(0)

Studying the factors of dissatisfaction from training and providing required information during labor was done on 14 factors; the most dissatisfaction in educational and non-educational hospitals was related to lack of introducing different caretakers and lack of explaining their duties (Table No. 3). Table 3: Causes of maternal dissatisfaction from training and providing required information in labor Dissatisfaction from training and providing required information in labor Introduced you different caretakers and explained you their duties. Showed you Available facilities in the unit and explained how to use it. Introduced you the washroom, bathroom and labor room. Described the uterine contractions to you. Explained you Before doing some care. Described you about the amount of opening of the cervix. Gave the description You need about eating and drinking. Explained you Before uterine examination. Informed you with the progress of labor and fetal status. Showed you fetal heart Auscultation device and explained how to use it. Explained breathing and meditation to reduce labor. Explained your position during the labor. If you have any questions, you could simply ask them. Explained Obstetric or medical terminology in a simple and understandable way. P-value=0/0001

educational N(%) 179(89.5) 175(87.5) 153(76.5) 132(66) 129(64.5) 94(47) 77(38.5) 76(38) 68(34) 63(31.5) 54(27) 52(26) 47(23.5) 37(28.5)

non-educational N(%) 43(61.4) 39(55.7) 17(24.3) 22(31.4) 27(38.6) 22(31.4) 9(12.9) 13(18.5) 8(11.4) 18(25.7) 9(12.9) 12(17.1) 10(14.3) 6(8.6)

Studying the factors of dissatisfaction from training and providing required information in delivery room was done on 9 factors; the most dissatisfaction in educational and non-educational hospitals was related to lack of training the stitched cleansing with disinfectants and genital hygiene (Table No. 4). Table 4: Causes of maternal dissatisfaction from training and providing required information in delivery dissatisfaction from training and providing required information in delivery Taught Washing stitched area with Disinfectants and genital hygiene. Informed you with the baby health Immediately after birth. Noticed you when removing the placenta. Notified your companions with the baby and your health and infant sex. Noticed you about the baby's sex Immediately after birth. Informed you When attempting to repair a perineal tear or cut. Noticed of finishing the perineal rupture repair. Explained pushing during childbirth. Taught you how to breathe during labor. P-value=0/0001

educational N(%) 49(24.5) 46(23) 35(17.5) 27(13.5) 22(11) 21(10.5) 20(10) 10(5) 10(5)

non-educational N(%) 9(12/8) 8(11/4) 7(10) 0(0) 0(0) 6(8.6) 5(7.1) 0(0) 0(0)

Studying the factors of dissatisfaction from ethical supports during labor was done on 9 factors; the most dissatisfaction in educational and non-educational hospitals was related to lack of attention to comments and suggestions in doing care except the urgent ones (Table No. 5).

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Faride Eghdampour et al Euro. J. Exp. Bio., 2013, 3(6):132-139 _____________________________________________________________________________ Table 5: Causes of maternal dissatisfaction of ethical support in labor dissatisfaction of ethical support in labor attention to comments and suggestions in doing care except the urgent ones Did not blame you for your behavior during labor. Used respectful words for their requests. prevent to put you in sight during Care affairs. Used your name politely. Knew helping you as their task. let the other people to observe or examine with your permission. Not Differentiate between you and other mothers. Accepted the responsibility for the actions that were taken. P-value=0/0001

educational N(%) 120(60) 91(45.5) 78(39) 76(38) 63(31.5) 51(25.5) 31(15.5) 17(8.5) 13(6.5)

non-educational N(%) 32(45.8) 19(27.2) 11(15.8) 23(32.9) 10(14.3) 10(14.3) 4(5.7) 4(5.7) 1(1.4)

Studying the factors of dissatisfaction from ethical supports in delivery room was done on 8 factors; the most dissatisfaction in educational and non-educational hospitals was related to lack of introducing different caretakers (Table No. 6). Table 6 Causes of maternal dissatisfaction of ethical support in labor dissatisfaction of ethical support in labor Introduced themselves to you. Prevented putting you insight of others. Refused to blame you for your behavior during childbirth. Used Simple words and expressions in the description of the delivery process. Knew helping you as their task Told you facts about the events that occurred during labor. Did their best not to harm you and the baby. Accepted the responsibility for the actions that were taken. P-value=0/0001

educational N(%) 179(89.5) 42(21) 39(19.5) 15(7.5) 15(7.5) 13(6.5) 12(6) 10(5)

non-educational N(%) 44(62.9) 7(10) 12(17.2) 1(1.4) 1(1.4) 0(0) 5(7.1) 1(1.4)

Studying the factors of dissatisfaction from emotional supports during labor was done on 9 factors; the most dissatisfaction in educational and non-educational hospitals was related to not allowing gripping the hand of mothers when they have pain (Table No. 7). Table 7: Causes of maternal dissatisfaction with emotional support during labor dissatisfaction with emotional support during labor allowed you to take their hands When you have pain They understand your situation during labor Your questions were answered thoroughly and patiently. Listening carefully to you. Spoke with a calm and warm tone. You were allowed to ask questions. they looked at you or gave attention to you When talking to you. Admired your cooperation in perform of cares and encouraged to continue cooperation. Showed composure in dealing with you. P-value=0/0001

educational N(%) 152(76) 94(47) 85(42.5) 78(39) 78(39) 76(38) 61(30.5) 53(26.5) 37(18.5)

non-educational N(%) 52(74.3) 15(21.4) 11(15.7) 10(14.3) 6(8.5) 9(12.8) 7(10) 10(14.3) 4(5.7)

Studying the factors of dissatisfaction from emotional supports in delivery room was done on 11 factors; the most dissatisfaction in educational and non-educational hospitals was related to lack of soothing and hugging mothers by different caretakers (Table No. 8). Table 8: Causes of maternal dissatisfaction with emotional support during delivery dissatisfaction with emotional support during delivery They soothed you. They hugged you. You could choose Labor factor between labor room carers. Held your hands. Allowed to have skin to skin contact with your baby. Let you shout or cry. were reassuring you in your infant health and the delivery process. Let you hug the infant after birth. Ensured you with their behavior and skills. Let you put your breasts in baby's mouth after the birth. Strengthened your safe feeling with their presence. P-value=0/014

educational N(%) 193(96.5) 192(96) 178(89) 161(80.5) 64(32) 45(22.5) 33(16.5) 19(9.5) 19(9.5) 18(9) 13(6.5)

non-educational N(%) 68(97.1) 68(97.1) 63(90) 58(82.9) 10(14.3) 7(10) 2(2.8) 10(14.3) 2(2.8) 17(24.3) 2(2.9)

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Faride Eghdampour et al Euro. J. Exp. Bio., 2013, 3(6):132-139 _____________________________________________________________________________ The results of study related to personal-social characteristics and midwifery with the factors of dissatisfaction showed that there was no statistically significant relationship between personal-social characteristics and midwifery with mothers’ dissatisfaction from physical cares and emotional supports (p≥0.05). The dissatisfaction from receiving required information has significantly statistical relationship with a number of live childbirth (p=0. 009), pre-familiarity about delivery (p=0. 024) and acquiring the information of subjects regarding the delivery procedure (p=0. 0001). The dissatisfaction from ethical supports has statistically significant relationship with source of acquiring information of research center regarding the delivery procedure (p=0. 0001). For comparing the factors of mothers’ dissatisfaction with labor and delivery care and supports among educational and non-educational hospitals in Tabriz, T test was used and the results of the test showed that there was a statistically significant difference between educational and non-educational hospitals in all 4 areas during labor and delivery. DISCUSSION AND CONCLUSION According to the results of current study, the mothers’ dissatisfaction from receiving their required information was high and the most dissatisfaction in labor was related to “lack of introducing different caretakers”, “lack of introducing ward, bathroom and WC”, “lack of introducing available possibilities and manner of using them”, “lack of explaining about uterine contractions, delivery progress”, “lack of explaining about different cares” respectively and the dissatisfaction of above ones was more than 50%. In a study done by Rudman & et.al (2007) showed that 33% of women were unsatisfied with cares of which 7% was related to receiving information and interfering in their decisions (16). The results of that study are consistent with the current study and the mothers’ dissatisfaction from receiving required information was high. In a study done by Brown & et.al (2007) in Australia, lack of enough information was one of the factors which the mothers mentioned as a factor of dissatisfaction from labor and delivery caretakers (17). From among the factors studies for defining the reasons of mothers’ dissatisfaction from physical labor cares during, the most factors were related to “lack of doing actions for reducing the delivery pain such as back massage, using drugs and etc.”, “not allowing mothers for walking in delivery room” and “lack of effort for reducing the noise in delivery room”. The results of Ordibeheshti’s study showed that in educational maternity hospital, the physical expectations of mothers from delivery caretakers were not estimated at 55.77% or it was estimated approximately (24.29%). In this study, the least expectation estimation was related to the question regarding supplying comfort and requirements of mother and regarding the setting for mother’s comfort (10). The results of this study do not correspond with the results of current study and mothers’ dissatisfaction from physical cares was decreased compared to Ordibeheshti’s study. It can be due to increasing the trainings related to physical cares from mothers, management’s more attention to promoting the quality of physical cares and decreasing the shortcomings related to physical cares. The results of study done by Mirmolaei & et.al (2003) showed that in Tehran hospitals, 68.75% of units are fully satisfied with physical supports in labor and delivery room (4). The most dissatisfaction of mothers from ethical supports in labor was related to “lack of attention to comments and suggestions on doing cares except the urgent ones”, “blaming mothers due to their behavior during delivery pain” and “not using the request kindly or accompanying words such as please”. Ordibeheshti showed in his study that mothers’ ethical expectations from delivery caretakers were not estimated in most of the cases (59.95%) or was estimated approximately (23.49%). The least estimation was related to getting permission from mother for doing an examination by others and kindly explaining the reason and not getting a comment from a mother in urgent cares (10). The results of Ordibeheshti’s study are consistent with current study. Assessing the factors of mothers’ dissatisfaction from emotional supports in labor showed that in all studies cases, the dissatisfaction ranged from 20% to 75% and the most dissatisfaction was due to not allowing the caretakers gripping the hands of mothers when they have pain. Mothers’ dissatisfaction during delivery is less than during labor and it may probably be due to the great number of caretakers during labor, stress accompanying pain and need to care, support and more attention to mothers which makes doing proper actions for encouraging the health team for doing support from mothers unavoidable. The most mothers’ dissatisfaction during delivery was related to emotional supports and it was related to “lack of soothing and hugging mothers during delivery”, “not having right for choosing the caretaker among different caretakers”, “not gripping the hand of mother during delivery”.

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Faride Eghdampour et al Euro. J. Exp. Bio., 2013, 3(6):132-139 _____________________________________________________________________________ The results of the present study showed that mothers' dissatisfaction with Care and Supports provided by labor and delivery care takers in educational and non-educational hospitals were statistically significant. Therefore, satisfaction in labor and delivery period was higher for non-educational hospitals. This lower rate of satisfaction can be justified due to the greater number of caretakers and students in educational hospitals. In non-educational hospitals, delivery process care was given by midwives (except for deliveries with side effects). In a study by Sandin & et.al (2011) in Spain regarding labor cares, 81% of mothers were satisfied with care and supports during labor and assessed their delivery experience as positive, the results of which are slightly different with the results of the current study in non-educational hospital and is was completely different with educational hospitals, the satisfaction of current study in mentioned hospitals are low. This inconsistency can be resulted from the different expectations of mothers and the type of service provided in different countries (18). In a study by Sharmi (2007), it became clear that treatment hospitals were more successful than educational hospitals in terms of gaining the satisfaction of pregnant women in prenatal care. The factor for this lower rate of satisfaction in educational hospitals is assumed to be the care indexes of educational hospitals (19). The limitations of the study included mothers' exhaustion with labor and too much attention to herself and the baby that may cause incorrect reply to questionnaire items. To help remove this problem, the questionnaires were completed after the stabilization of the mother's state or they were completed by the researcher. Using the simple sampling method, since all research units which have the requirements of entering the study, was entered into the study and random sampling was not used due to the great number of requirements for the study, this convenient sampling method reduces the generalization of results. Since the findings of this study showed that mothers' dissatisfaction rate in non-educational hospitals in which the delivery is made by the midwives under the supervision of women's and labor specialists is higher, it is suggested that in the coming studies, the role of the midwives in attracting the mothers' satisfaction be examined. Meanwhile, since the current study was done without considering the mother’s awareness of care standards, it is suggested that a study will be done entitled as “studying the reasons of mothers’ dissatisfaction with labor and delivery caretakers before and after receiving the care standards. Acknowledgement I do express my deep appreciation to the head, officials and personnel of the postpartum section of 29Bahman, Alzahraa (S) and Taleqani hospitals of Tabriz. Moreover, my thanks go to the Vice President for Research of Tabriz Medical Sciences University for providing the financial grants (code 88/8/5) of the project. REFERENCES [1] Page LA. The new midwifery science and sensitivity in practice. London: Churchill Livingstone; 2000: 106. [2] Fraser DM, Cooper MA. Myles textbook for midwives, London: Churchill Livingstone; 2003: 3-10. [3] Zolfaghari B, Kabiri P, Oveic Gharan SH. Esfahan Uni Med Sc J 1997; 3 (2): 136-142. [4] Jafari F, Johari Z, Zayeri F, Ramazankhani A, Sayah Iran Z. Shahed uni science-research J 2006; 14(66): 15-22. [5] Peterson W. Adolescent mothers `satisfaction with postpartum nursing care: quantitative and qualitative approaches [dissertation]. Unpublished PhD thesis, Mc master university; 2004. [6] Harvey S, Rach D, Stainton MC, Jarrell J, Brant R. Midwifery 2002; 18: 260-267. [7] Chunuan SK. Patient Satisfaction with Health Care Services Received During Intrapartum in One Regional Hospital in the Southern Part of Thailand. [dissertation]. Unpublished PhD thesis, University Of Kentucky; 2002. [8] Mackey MC, Flanders Stepans ME. JOGNN 2006; 23(5): 413-420. [9] Kabakian-Khasholian T, Campbell O, Shediac-Rizkallah M, Ghorayeb F. Social Science & Medicine 2000; 51: 103-113. [10] Ordibeheshti Khiaban M. [Rate Women`s Expectation of Maternal Care Givers in Education Tabriz Maternity Hospitals]. [Dissertation]. Un published Master`s thesis, Tabriz Nursing &Midwifery faculty, Iran; 1998. [11] Mirmolaei S, Khakbazan Z, Kazemnead A, Azari M. Tehran Uni Med Sc J (Hayat) 2007; 13 (2): 31-40. [12] Daff La, Lamping D,Ahmed LB. International journal quality in health care 2001; 17(3): 215-230. [13] Robledo IJ. The impact of childbirth preparation and support on labor and birth outcome. [Dissertation]. Unpublished PhD thesis, university of Rhode Island: 1997. [14] Waldenstrom U, Brown S, Mclachlan H, Forster D, Brennecke S. Birth 2000; 27(3): 156-167 [15] Mirmolaei S, Mehran A, Rahimi Ghasbeh S. Tehran Uni Med Sc J (Hayat) 2004; 9 (17): 41-47. [16] Rudman A, El-Khouri B, Waldenstrom U. Journal of Advanced Nursing 2007, 59(5), 474–487.

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Faride Eghdampour et al Euro. J. Exp. Bio., 2013, 3(6):132-139 _____________________________________________________________________________ [17] Stephanie Brown BA, Lumley J. Birth 2007, 21(1), 13-4. [18] Sandin A, Kvist L, Berg M, Larsson B. International Journal of Health Care Quality Assurance 2011; 24(1):81-95. [19] Sharami SH, Zahiri H, Zendedel S. Gilan Uni Med Sc J 2007; 17 (66): 29-37.

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