Explaining the process care by companion midwife during childbirth: study protocol

Explaining the process care by companion midwife during childbirth: study protocol | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Study protocol Explaining the process care by companion midwife during childbirth: study protocol Narges Sadat Soltani, Samira Ebrahimzadeh Zagam, Leili Hafizi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4091442/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The World Health Organization emphasizes the existence of a birth companion in order to improve the care results and satisfaction of mothers in labor and delivery. Due to the fact that the process of care by a companion midwife during childbirth is unknown and the existing challenges are identified, this study will be conducted with the aim of explaining the process of care by companion midwife during childbirth. Methods: It is a qualitative research with a grounded theory approach that the main participants of the study are midwives. Sampling has been started in a Purposive sampling and will continue based on the resulting categories until data saturation in the form of theoretical sampling. Data collection will be done using in-depth semi-structured interviews, field notes and reminders. The Strauss and Corbin 2015 method will be used for data analysis, which includes five steps: Identification of concepts, development of concepts according to their characteristics and dimensions, data analysis for context, bringing the process into the analysis and integration of categories. Discussion: This study is expected to contribute to a better understanding of care by companion midwives. Because this study will identify the obstacles and facilitators of the implementation of the companion midwifery program in maternity settings. Ethical code: IR.MUMS.NURSE.REC.1402.130 companion midwife childbirth care process Plain English Summary The regulation of companion midwife in Iran has been promulgated since 2009, but field reports show that a small percentage of births are performed with the support of companion midwife. A companion midwife in Iran is a trained midwife and a university graduate, despite the many benefits of the presence of a companion midwife reported in studies around the world and in Iran, but this is associated with challenges, so this study will be done with the aim of explain the process of care by companion midwife during childbirth with a grounded theory approach. The companion midwives will be the main participants who will take care of the mother from the beginning of labor and admission to the delivery room until discharge Background Childbirth is an important life event because it not only means the beginning of a new life, but the process of birth itself is of great importance ( 1 ). One of the successful and promising policies that lead to promoting natural childbirth, improving pregnancy outcomes and improving women's experiences, is care by a doula ( 2 ), and it can be considered one of the most positive childbirth interventions in the last 20 years ( 3 ). Care by a doula is a potential strategy to reduce unnecessary medical interventions during childbirth ( 4 ) and an important yet underutilized resource in improving maternal health equity ( 5 ). Doula is a Greek word meaning "female servant"( 6 , 7 ). Doula care includes emotional support (constant presence, reassurance, encouragement and praise), physical support (reducing thirst, hunger and pain), providing information about the birth process and how to cope with it, respecting the woman's decision and helping her in Establishing relationships with other caregivers ( 8 , 9 ). A doula does not perform any medical intervention in the delivery room and does not replace the role of the spouse or other family members who may be present. However, she provides continuous and uninterrupted emotional and physical support during labor. This continuity of care, provision of human presence and social support is unique to the role of a doula, which distinguishes it from any other support model ( 10 ). The World Health Organization (2020) has reported the percentage of the existence of a national policy or guide for the presence of a chosen companion during labor and birth in different countries without referring to the presence of a doula or companion in births in different regions of the world, that the highest amount of national guidelines for childbirth belongs to the countries of America, Southeast Asia and Europe respectively with 76, 73 and 72%, and the least guidelines for attendance with childbirth related to Eastern Mediterranean countries were reported as 19%, while the organization World Health emphasizes the presence of companions in childbirth for three reasons: creating pleasant experiences of pregnancy and childbirth, increasing the number of natural births, and improving the health of mothers and babies ( 11 ). Iran is one of the few countries in the Eastern Mediterranean that has compiled and implemented a regulation under the title of the regulatory regulation of companion midwife in 2009 ( 12 ). In Iran, a doula is interpreted as a companion midwife, and with the conducted investigations, no documented statistics were found on the presence of companion midwives at the bedside, and more studies investigated the effect of companion midwife on the outcome of childbirth ( 13 – 15 ). The results of a meta-analysis (1999) conducted on 11 randomized clinical trials showed that continuous support during labor and delivery by trained people (doula) led to decrease in the duration of Labor, less use of painkillers and oxytocin, less use of Forceps and caesarean reduction ( 16 ). The presence of a birth doula also has positive effects on women's mental health during childbirth and postpartum, including reducing maternity anxiety, increasing self-confidence during childbirth, and reducing postpartum depression ( 17 ). Doula are also people who help the mother start breastfeeding and build a bond with her baby ( 18 ). Despite the confirmation of the positive role of the companion midwife on the outcomes of childbirth and the promotion of natural childbirth in Iran ( 13 – 15 ) and the emphasis of the World Health Organization (2020) on the fact that supporting women to have an elected or companion during labor and childbirth is a low-cost and effective intervention ( 11 ) but in Iran, due to the legality of the companion midwife in hospitals, it is not possible be present companion midwife in all educational hospitals, and even their entry is prevented. According to the statements of Mohammad Khani, a member of the board of directors of the Tehran Medical System in May 1401, due to the conflict between the interests of midwives and gynecologists, regulation of companion midwife are not implemented in some hospital ( 23 ). Ahlemeyer and Mahon (2015) also reported that sometimes doula's role as a member of the healthcare team in the hospital environment leads to a darkening of the relationship between midwife and doula due to confusion about roles, motives and perspectives ( 19 ). McLeish et al. (2017), in order to examine the experiences of doula and mothers and how doula communicate with midwives in the UK have conducted a qualitative study of the phenomological method, and in general three themes were achieved " doula as a complement", "as a colleague" and as a "challenge for midwives" ( 20 ). Adams et al. (2021) reported in their study that the doula -physician relationship is a complex story of power, respect, and mutual responses. Since the doulas do not have a therapeutic position and have a holistic approach to birth, they may cause conflicts in the delivery room. The researchers emphasize that given the importance of implementing a continuous support program for mothers, the perception of midwives and obstetricians and their relationships with doula is an important line of research, as the situation and roles affect how they communicate with each other ( 21 ). Care is a phenomenon that is expressed and experienced differently in different cultures. Also Leininger describes care as a complex phenomenon with 12 common dimensions that include respect, concern, attention, help, active listening, presence, understanding, communication, protection, touch, comfort and love are filial ( 22 ). Care by a companion midwife or doula is also in line with the physiosocial midwifery model, or according to Wagner, human care. Companion midwives or doulas respect women's independence and increase women's empowerment, confidence, and self-efficacy during childbirth ( 23 ). Although the model of care by a doula is almost clear, the process of care by a doula (Companion midwives) is not clear. Measuring care processes is an important part of efforts to improve the quality of care, because care systems can vary internationally as well as regionally ( 24 ). The study will attempt to determine the process of care by the companion midwife. Among the various methods of qualitative research, if the phenomenon is known in the social context and the study of social phenomena hidden in human interactions is desired, the grounded theory method is used ( 25 ). In addition, grounded theory is one of the most suitable types of research methodology for the less known areas related to social processes in human interactions ( 26 ). Study aim: Due to the fact that it seems that the process of care by Companion midwives during childbirth in Iran is not well understood and explained, by obtaining the results of this study, we can gain a deep insight into the experiences of Companion midwives in the delivery room and how they interact with obestricans and midwives working in the maternity hospital. Therefore, the current research will be designed with the aim of explaining the process of care by Companion midwives during childbirth using the ground theory method. Objectives: Explanation of the care process by Companion midwives during childbirth Some examples of questions that will be asked in the interview: When you go to the maternity hospital as a Companion midwife for maternal care, what kind of care do you give to mothers? What is the reaction of pregnant mothers to the care provided by you as Companion midwife? How are your interactions with other members of the treatment team? What do they (midwives and specialists) do during your presence? What are your experiences of dealing with them? What are the factors that facilitate companion midwife care? What are the barriers to companion midwife care? And how do you handle it? Methods/design To conduct this study, in the first stage, a qualitative approach of the grounded theory of Corbin and Strauss, version 2015, will be used. In this study, the researcher will try to understand and explain the care process by the Companion midwives during childbirth in interaction with Companion midwives and working midwives and gynecologists. Also, the researcher will try to use unstructured observations and open and deep interviews (methodology - to get a deep and rich understanding of what these participants experienced), and by reflecting the facts and statements from the voice of the participants bring them to the ears of others (linguistics). This study seeks to discover the care process of Companion midwives during childbirth, which is affected by their interaction with the surrounding environment (doctor, midwife, ward officials, pregnant mother and her family. After receiving the approval of the ethics committee and sampling letter; the researcher will be went to Sampling environments (interviews will be conducted in Mashhad midwifery Consulting offices, public and private Mashhad hospitals, or in places based on the wishes of the participants). In order to achieve data saturation from targeted sampling with. Maximum variation sampling strategy for Companion midwives in terms of age, work experience, employment status, education level, working in a public or private hospital and in the case of mothers admitted to the maternity hospital in terms of Number of pregnancy, type of delivery, duration of labor, birth agent and in the case of midwives and officials, it will be used according to their position. In order to conduct official interviews, first, explanations will be given about the objectives of the study, in order to obtain the consent of the people to conduct the research. After communicating with the participants, a suitable time and place will be determined for the interview. With prior coordination, the researcher will also be present, in during the presence of Companion midwives in Maternity ward or consulting offices. Also, the researcher will sometimes enter the maternity ward as a trainer for midwifery students in the morning and evening shifts. The researcher will try to gain the trust of the participants by cooperating in the implementation of midwifery procedures and patient care and will also observe while doing the work. To record field notes while in the department, the researcher is content to write down the key points of the observations along with the time and date and will complete his notes as soon as possible. During the observation, if a question arises for the researcher, he tries to answer the question using interviews and informal conversations during the observation. In order to access information, the selection of key informants will be purpose-based. Data collection will continue until a rich description of the phenomenon of continuous care by Companion midwives is reached. The main method of data collection in this research will be a semi-structured in-depth interview using open questions. In order to deepen the interview and make it more complete and obtain richer data based on the type of responses of the participants, exploratory or investigative expressions will be used. Interviews will be conducted in one or two or more times according to environmental and time factors and other factors. The duration of the interviews depends on the willingness of the interviewee to continue the interview and fully present his ideas. In all interviews, the interview will begin with a general question that will be slightly different according to the type of participant. The interview will start with general questions and with the least possible structure from the Companion midwives. For example, "Tell me about your experience as a Companion midwife?" And gradually, the questions become more specific during the research process, so that specific concepts can be investigated in more depth. For example, these questions will be asked, "When you go to the delivery room for maternal care, what kind of care do you give to mothers? Or what do midwives and specialists do during your presence? What are your experiences of dealing with them?" based on the answers and data Appeared from the participant, clarifying and deepening interview questions such as "Tell me more about this... and then with exploratory questions such as "What for example", "What does that mean", "What do you mean by... What is? What does this mean? "Please explain more" continues. At the end of the interview, the participants will be asked to explain the conversation or important point that they did not say and needs to be raised. Finally, with some other open questions such as: anything else don't agree? If you remember something after I left, or if you change your mind about what you said, you can contact me again, the interview will be terminated. From other contributors Questions will also be asked. For example, the question to hospitalized mothers will be like this: "How was your experience of giving birth with a Companion midwife?" Or the specialists or midwives working in the hospital will be asked this question, "How are your experiences with the presence of a Companion midwife?" These types of general questions allow participants to freely describe their understanding and experience. Also, questions in this field will be asked from family members and other people who will probably be interviewed based on theoretical sampling. Another tool for data collection in this study will be field notes, which will be used to document observations and data analysis. Observation is suitable as a complementary method for collecting data and explaining unspoken behaviors. Observation in the field creates an opportunity for the researcher to identify and understand the behavior and the context that leads to its occurrence ( 27 ). The researcher will take notes of what he sees, hears or thinks and experiences (how to sit, talk, facial expressions and other observations that we cannot record through sound recording - field notes), and at the first opportunity later will record the interview. Also, every idea that comes to the mind of the researcher while reading the interviews or codes will be written down (note writing). The interviews will be recorded by a tape recorder and written permission will be obtained from the participants before recording their voices. Immediately after the end of the interviews, all of them will be transcribed word by word from the tape recorder. It may be necessary to change and modify the interview guide with the progress of research and the gradual construction of categories which will be done Inclusion criteria (Companion midwive) Willingness to cooperate and participate in the study Having at least one year of experience as a Companion midwive Having the necessary ability to provide experiences Data analysis In this study, from the beginning of the research, data collection and analysis process will be done simultaneously. The interview file with the participants will be listened to several times to get a general understanding of it. In the following, the interviews will be written word by word. MAXQDA software version 2010 will be used to manage and organize data. For data analysis, the coding paradigm of Strauss and Corbin 2015 will be used. Due to the more systematic method of coding and analysis, the clarity of the research question in advance, more attention to the role of the researcher in the latest version and personal interest, the researcher chose the Corbin and Strauss 2015. Therefore, in the present study, the content analysis of the conducted interviews will be a regular and continuous process of data comparison, and for this, a five-step process including Identification of concepts, development of concepts according to their characteristics and dimensions, data analysis for context, bringing the process into the analysis and integration of categories ( 28 ). Four criteria are used to evaluate the trustworthiness of the collected data based on Lincoln and Guba's Criteria (1985) (Credibility, Dependability, Confirmability, Transferability (( 29 , 30 ). Sample size and sampling method In Grounded Theory, purposeful sampling (based on purpose) is used; because the goal is to choose people who are a rich source of information so that they can actively participate in the study and help the researcher to better understand their life and social interactions ( 28 ). In qualitative research, it is not possible to determine the sample size beforehand and it is determined during the study. The end of sampling will be when no new classes or suitable themes emerge and the main classes are sufficiently developed in depth and variability ( 31 ). In the present study, theoretical sampling is a part of the data collection and analysis process, which is used to fill the classes and develop the theory and continues until saturation is reached. Discussion The review of the conducted research shows that there are no comprehensive qualitative studies, especially with the grounded theory approach, about the care process by a doula or Companion midwife. The studies carried out are mainly in other countries and have been conducted only to examine the limited experiences of doulas without considering the background conditions and social background. In the limited studies that have been conducted using the qualitative method, it is dedicated to the experiences and not to the discovery of the care process of doulas and not Companion midwives. In these studies, some aspects of the perception and experience of mothers and midwives regarding doulas have been examined, and other people who interact with doulas or Companion midwives have been less investigated. While obtaining the opinions of other people involved with doulas, gynecologists, department officials, expectant mothers and their families is also important ( 8 , 20 , 21 , 32 ). Considering the dominant role that obstetricians and gynecologists play in maternity care in many countries, this is an important area that needs more attention. In some studies, interviews were conducted only with midwives who had worked with doulas and the opinions of other midwives were not taken into account ( 33 ). The method of data collection in most studies was only interviews ( 8 , 20 , 21 , 32 , 33 ), even some interviews were conducted by telephone ( 20 ), while in order to investigate the interactions of people with each other, it is necessary It is also to be observed. Also, most of the studies abroad are focused on vulnerable women such as immigrants and black people ( 20 , 32 ). In some studies, professional doulas were not used, but people who were willing to be doulas with the pregnant mother were trained and then they were used in the study ( 10 , 20 ). Professional doulas were also people who did not have a university education, but only took courses and had a doula certificate. But in Iran, a doula means a Companion midwife who has a university education in midwifery and has also completed courses such as physiological childbirth and childbirth pain relief methods to accompany the mother. Therefore, it is true that she does the work of a doula, but she may be slightly different from a doula due to her knowledge of the birth process and her education, her experiences and understanding, and the challenges that may occur in her interactions. Therefore, it is necessary to check the care process by Companion midwife. Also, in Iran, few studies have been conducted on birth attendants, which are mostly focused on the benefits and advantages of using birth attendants ( 13 , 15 ), which adds to the importance of the research in the present study, but no qualitative study has been conducted in Iran. Also, no qualitative study was found that examines the care process of a doula (Companion midwife). Because in Grand Theory, in addition to interviews, observation is also used to collect data, so it is better to check people's interactions. Also, in the present study, interviews will be conducted with all the people who interact with midwives in some way, such as ward officials, midwives, pregnant mothers and their families, provincial and national officials. Therefore, the researcher decided to investigate the process of care provided by the Companion midwife in Iran by the Grounded Theory. This study is expected to contribute to a better understanding of care by Companion midwife. Because this study will identify the barriers and facilitators of care by Companion midwife in maternity settings. Also, the findings of this study will help the policy makers and national managers to implement the mother-in-law program, which, in addition to benefiting mothers from the benefits of continuous support, will also lead to the improvement of natural childbirth and childbirth. Abbreviations WHO World Health Organization MAXQDA Qualitative Data Analysis Software UK United Kingdom Declarations Ethics approval and consent to participate The project with the code 4020618 has been approved by the Research Vice-Chancellor of Mashhad University of Medical Sciences, Faculty of Nursing and Midwifery, Research Center for Nursing and Midwifery Care. Before conducting the interview, written permission will be obtained from all the participants. Consent for publication Not applicable. Availability of data and materials Not applicable. Competing interests The authors declare that they have no competing interests. Funding Mashhad University of Medical Sciences Authors’ contributions NS: Writing a proposal, sampling and conducting interviews, analyzing data, writing an article SE: Ground theory consultant, method review LH: Cooperation in the implementation of the proposal NJ: Final check of the proposal, supervision of work implementation, Final review of the article Acknowledgements I would like to thank the Research Vice-Chancellor of Mashhad University, Nursing and Midwifery Care Research Center for their cooperation in the implementation of this project. I also thank in advance all the participants, whom I will interview. References Armanmehr V, Banafshe E, Hashemizadeh H, Alami A, Khajavi A. Midwives’ Perception Regarding Conditions Influencing the Implementation of the Natural Childbirth Promotion Program in Iran: A Qualitative Study. 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Trustworthiness in qualitative research. Medsurg nursing. 2016;25(6):435. Corbin J, Strauss A. Basics of Qualitative Research (3rd ed.): Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, California2008. Available from: https://methods.sagepub.com/book/basics-of-qualitative-research. Haugaard A, Tvedte SL, Severinsen MS, Henriksen L. Norwegian multicultural doulas' experiences of supporting newly-arrived migrant women during pregnancy and childbirth: A qualitative study. Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives. 2020;26:100540. https://doi.org/10.1016/j.srhc.2020.100540. Stevens J, Dahlen H, Peters K, Jackson D. Midwives’ and doulas’ perspectives of the role of the doula in Australia: A qualitative study. Midwifery. 2011;27(4):509-16. https://doi.org/10.1016/j.midw.2010.04.002Get rights and content. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4091442","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Study protocol","associatedPublications":[],"authors":[{"id":280632533,"identity":"e62e7f14-134c-4cce-bcfe-9dad48cef31c","order_by":0,"name":"Narges Sadat Soltani","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Narges","middleName":"Sadat","lastName":"Soltani","suffix":""},{"id":280632534,"identity":"f3c92f04-afe2-426e-a4a1-b0bb48ebe706","order_by":1,"name":"Samira Ebrahimzadeh Zagam","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Samira","middleName":"Ebrahimzadeh","lastName":"Zagam","suffix":""},{"id":280632535,"identity":"c61a04dd-0d55-4ba9-a77d-b381ee59a155","order_by":2,"name":"Leili Hafizi","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Leili","middleName":"","lastName":"Hafizi","suffix":""},{"id":280632536,"identity":"4e2f27e3-7dfc-4122-943a-360c4a399186","order_by":3,"name":"Nahid Jahani Shourab","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYBACxgYeIGnAkMDAzHwAyJKQIUELO1sCSAsPEfZA1CQw8PMYILj4AHP72YOfCwrq8syZeT6/ulFjwcPAfvjoBrwO68lLlp5hcLjYspl3m3XOMaDDeNLSbuD3S46BNI/BgcQNh3m3GeewAbVI8Jjh19L/xvg3j0EdUAvPM+Ocf8RomZFjBrSFGaSF+XFuG1Fa3phZ8xgcBmphM2PO7ZPgYSPkF8P+HOPbPH+ADjt/+PHnnG91cvzsh4/h19KAYLNJgEl8ykFAHonN/IGQ6lEwCkbBKBiZAAAhBUSKQgsUiQAAAABJRU5ErkJggg==","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Nahid","middleName":"Jahani","lastName":"Shourab","suffix":""}],"badges":[],"createdAt":"2024-03-13 09:46:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4091442/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4091442/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53245882,"identity":"bb66214c-22bc-402a-9973-1b67829d5159","added_by":"auto","created_at":"2024-03-22 11:15:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":258296,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4091442/v1/c11b68c5-a54b-4163-a5ae-a566b9fac5b0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Explaining the process care by companion midwife during childbirth: study protocol","fulltext":[{"header":"Plain English Summary","content":"\u003cp\u003eThe regulation of companion midwife in Iran has been promulgated since 2009, but field reports show that a small percentage of births are performed with the support of companion midwife. A companion midwife in Iran is a trained midwife and a university graduate, despite the many benefits of the presence of a companion midwife reported in studies around the world and in Iran, but this is associated with challenges, so this study will be done with the aim of explain the process of care by companion midwife during childbirth with a grounded theory approach. The companion midwives will be the main participants who will take care of the mother from the beginning of labor and admission to the delivery room until discharge\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eChildbirth is an important life event because it not only means the beginning of a new life, but the process of birth itself is of great importance (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). One of the successful and promising policies that lead to promoting natural childbirth, improving pregnancy outcomes and improving women's experiences, is care by a doula (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), and it can be considered one of the most positive childbirth interventions in the last 20 years (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Care by a doula is a potential strategy to reduce unnecessary medical interventions during childbirth (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) and an important yet underutilized resource in improving maternal health equity (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Doula is a Greek word meaning \"female servant\"(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Doula care includes emotional support (constant presence, reassurance, encouragement and praise), physical support (reducing thirst, hunger and pain), providing information about the birth process and how to cope with it, respecting the woman's decision and helping her in Establishing relationships with other caregivers (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). A doula does not perform any medical intervention in the delivery room and does not replace the role of the spouse or other family members who may be present. However, she provides continuous and uninterrupted emotional and physical support during labor. This continuity of care, provision of human presence and social support is unique to the role of a doula, which distinguishes it from any other support model (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The World Health Organization (2020) has reported the percentage of the existence of a national policy or guide for the presence of a chosen companion during labor and birth in different countries without referring to the presence of a doula or companion in births in different regions of the world, that the highest amount of national guidelines for childbirth belongs to the countries of America, Southeast Asia and Europe respectively with 76, 73 and 72%, and the least guidelines for attendance with childbirth related to Eastern Mediterranean countries were reported as 19%, while the organization World Health emphasizes the presence of companions in childbirth for three reasons: creating pleasant experiences of pregnancy and childbirth, increasing the number of natural births, and improving the health of mothers and babies (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Iran is one of the few countries in the Eastern Mediterranean that has compiled and implemented a regulation under the title of the regulatory regulation of companion midwife in 2009 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In Iran, a doula is interpreted as a companion midwife, and with the conducted investigations, no documented statistics were found on the presence of companion midwives at the bedside, and more studies investigated the effect of companion midwife on the outcome of childbirth (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e–\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The results of a meta-analysis (1999) conducted on 11 randomized clinical trials showed that continuous support during labor and delivery by trained people (doula) led to decrease in the duration of Labor, less use of painkillers and oxytocin, less use of Forceps and caesarean reduction (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The presence of a birth doula also has positive effects on women's mental health during childbirth and postpartum, including reducing maternity anxiety, increasing self-confidence during childbirth, and reducing postpartum depression (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Doula are also people who help the mother start breastfeeding and build a bond with her baby (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Despite the confirmation of the positive role of the companion midwife on the outcomes of childbirth and the promotion of natural childbirth in Iran (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e–\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and the emphasis of the World Health Organization (2020) on the fact that supporting women to have an elected or companion during labor and childbirth is a low-cost and effective intervention (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) but in Iran, due to the legality of the companion midwife in hospitals, it is not possible be present companion midwife in all educational hospitals, and even their entry is prevented. According to the statements of Mohammad Khani, a member of the board of directors of the Tehran Medical System in May 1401, due to the conflict between the interests of midwives and gynecologists, regulation of companion midwife are not implemented in some hospital (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Ahlemeyer and Mahon (2015) also reported that sometimes doula's role as a member of the healthcare team in the hospital environment leads to a darkening of the relationship between midwife and doula due to confusion about roles, motives and perspectives (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMcLeish et al. (2017), in order to examine the experiences of doula and mothers and how doula communicate with midwives in the UK have conducted a qualitative study of the phenomological method, and in general three themes were achieved \" doula as a complement\", \"as a colleague\" and as a \"challenge for midwives\" (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Adams et al. (2021) reported in their study that the doula -physician relationship is a complex story of power, respect, and mutual responses. Since the doulas do not have a therapeutic position and have a holistic approach to birth, they may cause conflicts in the delivery room. The researchers emphasize that given the importance of implementing a continuous support program for mothers, the perception of midwives and obstetricians and their relationships with doula is an important line of research, as the situation and roles affect how they communicate with each other (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCare is a phenomenon that is expressed and experienced differently in different cultures. Also Leininger describes care as a complex phenomenon with 12 common dimensions that include respect, concern, attention, help, active listening, presence, understanding, communication, protection, touch, comfort and love are filial (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Care by a companion midwife or doula is also in line with the physiosocial midwifery model, or according to Wagner, human care. Companion midwives or doulas respect women's independence and increase women's empowerment, confidence, and self-efficacy during childbirth (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Although the model of care by a doula is almost clear, the process of care by a doula (Companion midwives) is not clear. Measuring care processes is an important part of efforts to improve the quality of care, because care systems can vary internationally as well as regionally (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The study will attempt to determine the process of care by the companion midwife.\u003c/p\u003e \u003cp\u003eAmong the various methods of qualitative research, if the phenomenon is known in the social context and the study of social phenomena hidden in human interactions is desired, the grounded theory method is used (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In addition, grounded theory is one of the most suitable types of research methodology for the less known areas related to social processes in human interactions (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eStudy aim:\u003c/h2\u003e \u003cp\u003eDue to the fact that it seems that the process of care by Companion midwives during childbirth in Iran is not well understood and explained, by obtaining the results of this study, we can gain a deep insight into the experiences of Companion midwives in the delivery room and how they interact with obestricans and midwives working in the maternity hospital. Therefore, the current research will be designed with the aim of explaining the process of care by Companion midwives during childbirth using the ground theory method.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eObjectives:\u003c/h2\u003e \u003cp\u003eExplanation of the care process by Companion midwives during childbirth\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSome examples of questions that will be asked in the interview:\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eWhen you go to the maternity hospital as a Companion midwife for maternal care, what kind of care do you give to mothers?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhat is the reaction of pregnant mothers to the care provided by you as Companion midwife?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHow are your interactions with other members of the treatment team?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhat do they (midwives and specialists) do during your presence?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhat are your experiences of dealing with them?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhat are the factors that facilitate companion midwife care?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhat are the barriers to companion midwife care? And how do you handle it?\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e "},{"header":"Methods/design","content":"\u003cp\u003eTo conduct this study, in the first stage, a qualitative approach of the grounded theory of Corbin and Strauss, version 2015, will be used. In this study, the researcher will try to understand and explain the care process by the Companion midwives during childbirth in interaction with Companion midwives and working midwives and gynecologists. Also, the researcher will try to use unstructured observations and open and deep interviews (methodology - to get a deep and rich understanding of what these participants experienced), and by reflecting the facts and statements from the voice of the participants bring them to the ears of others (linguistics). This study seeks to discover the care process of Companion midwives during childbirth, which is affected by their interaction with the surrounding environment (doctor, midwife, ward officials, pregnant mother and her family. After receiving the approval of the ethics committee and sampling letter; the researcher will be went to Sampling environments (interviews will be conducted in Mashhad midwifery Consulting offices, public and private Mashhad hospitals, or in places based on the wishes of the participants). In order to achieve data saturation from targeted sampling with. Maximum variation sampling strategy for Companion midwives in terms of age, work experience, employment status, education level, working in a public or private hospital and in the case of mothers admitted to the maternity hospital in terms of Number of pregnancy, type of delivery, duration of labor, birth agent and in the case of midwives and officials, it will be used according to their position. In order to conduct official interviews, first, explanations will be given about the objectives of the study, in order to obtain the consent of the people to conduct the research. After communicating with the participants, a suitable time and place will be determined for the interview. With prior coordination, the researcher will also be present, in during the presence of Companion midwives in Maternity ward or consulting offices. Also, the researcher will sometimes enter the maternity ward as a trainer for midwifery students in the morning and evening shifts.\u003c/p\u003e\u003cp\u003eThe researcher will try to gain the trust of the participants by cooperating in the implementation of midwifery procedures and patient care and will also observe while doing the work. To record field notes while in the department, the researcher is content to write down the key points of the observations along with the time and date and will complete his notes as soon as possible. During the observation, if a question arises for the researcher, he tries to answer the question using interviews and informal conversations during the observation. In order to access information, the selection of key informants will be purpose-based. Data collection will continue until a rich description of the phenomenon of continuous care by Companion midwives is reached.\u003c/p\u003e\u003cp\u003eThe main method of data collection in this research will be a semi-structured in-depth interview using open questions. In order to deepen the interview and make it more complete and obtain richer data based on the type of responses of the participants, exploratory or investigative expressions will be used. Interviews will be conducted in one or two or more times according to environmental and time factors and other factors. The duration of the interviews depends on the willingness of the interviewee to continue the interview and fully present his ideas. In all interviews, the interview will begin with a general question that will be slightly different according to the type of participant. The interview will start with general questions and with the least possible structure from the Companion midwives. For example, \"Tell me about your experience as a Companion midwife?\" And gradually, the questions become more specific during the research process, so that specific concepts can be investigated in more depth. For example, these questions will be asked, \"When you go to the delivery room for maternal care, what kind of care do you give to mothers? Or what do midwives and specialists do during your presence? What are your experiences of dealing with them?\" based on the answers and data Appeared from the participant, clarifying and deepening interview questions such as \"Tell me more about this... and then with exploratory questions such as \"What for example\", \"What does that mean\", \"What do you mean by... What is? What does this mean? \"Please explain more\" continues. At the end of the interview, the participants will be asked to explain the conversation or important point that they did not say and needs to be raised. Finally, with some other open questions such as: anything else don't agree? If you remember something after I left, or if you change your mind about what you said, you can contact me again, the interview will be terminated. From other contributors Questions will also be asked. For example, the question to hospitalized mothers will be like this: \"How was your experience of giving birth with a Companion midwife?\" Or the specialists or midwives working in the hospital will be asked this question, \"How are your experiences with the presence of a Companion midwife?\"\u003c/p\u003e\u003cp\u003eThese types of general questions allow participants to freely describe their understanding and experience. Also, questions in this field will be asked from family members and other people who will probably be interviewed based on theoretical sampling. Another tool for data collection in this study will be field notes, which will be used to document observations and data analysis. Observation is suitable as a complementary method for collecting data and explaining unspoken behaviors. Observation in the field creates an opportunity for the researcher to identify and understand the behavior and the context that leads to its occurrence (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The researcher will take notes of what he sees, hears or thinks and experiences (how to sit, talk, facial expressions and other observations that we cannot record through sound recording - field notes), and at the first opportunity later will record the interview. Also, every idea that comes to the mind of the researcher while reading the interviews or codes will be written down (note writing). The interviews will be recorded by a tape recorder and written permission will be obtained from the participants before recording their voices. Immediately after the end of the interviews, all of them will be transcribed word by word from the tape recorder. It may be necessary to change and modify the interview guide with the progress of research and the gradual construction of categories which will be done\u003c/p\u003e\u003cp\u003e \u003cb\u003eInclusion criteria (Companion midwive)\u003c/b\u003e \u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWillingness to cooperate and participate in the study\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHaving at least one year of experience as a Companion midwive\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHaving the necessary ability to provide experiences\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eIn this study, from the beginning of the research, data collection and analysis process will be done simultaneously. The interview file with the participants will be listened to several times to get a general understanding of it. In the following, the interviews will be written word by word. MAXQDA software version 2010 will be used to manage and organize data. For data analysis, the coding paradigm of Strauss and Corbin 2015 will be used. Due to the more systematic method of coding and analysis, the clarity of the research question in advance, more attention to the role of the researcher in the latest version and personal interest, the researcher chose the Corbin and Strauss 2015. Therefore, in the present study, the content analysis of the conducted interviews will be a regular and continuous process of data comparison, and for this, a five-step process including Identification of concepts, development of concepts according to their characteristics and dimensions, data analysis for context, bringing the process into the analysis and integration of categories (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFour criteria are used to evaluate the trustworthiness of the collected data based on Lincoln and Guba's Criteria (1985) (Credibility, Dependability, Confirmability, Transferability ((\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003ch2\u003eSample size and sampling method\u003c/h2\u003e\u003cp\u003eIn Grounded Theory, purposeful sampling (based on purpose) is used; because the goal is to choose people who are a rich source of information so that they can actively participate in the study and help the researcher to better understand their life and social interactions (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In qualitative research, it is not possible to determine the sample size beforehand and it is determined during the study. The end of sampling will be when no new classes or suitable themes emerge and the main classes are sufficiently developed in depth and variability (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). In the present study, theoretical sampling is a part of the data collection and analysis process, which is used to fill the classes and develop the theory and continues until saturation is reached.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe review of the conducted research shows that there are no comprehensive qualitative studies, especially with the grounded theory approach, about the care process by a doula or Companion midwife. The studies carried out are mainly in other countries and have been conducted only to examine the limited experiences of doulas without considering the background conditions and social background. In the limited studies that have been conducted using the qualitative method, it is dedicated to the experiences and not to the discovery of the care process of doulas and not Companion midwives. In these studies, some aspects of the perception and experience of mothers and midwives regarding doulas have been examined, and other people who interact with doulas or Companion midwives have been less investigated. While obtaining the opinions of other people involved with doulas, gynecologists, department officials, expectant mothers and their families is also important (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Considering the dominant role that obstetricians and gynecologists play in maternity care in many countries, this is an important area that needs more attention. In some studies, interviews were conducted only with midwives who had worked with doulas and the opinions of other midwives were not taken into account (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe method of data collection in most studies was only interviews (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), even some interviews were conducted by telephone (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), while in order to investigate the interactions of people with each other, it is necessary It is also to be observed.\u003c/p\u003e \u003cp\u003eAlso, most of the studies abroad are focused on vulnerable women such as immigrants and black people (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). In some studies, professional doulas were not used, but people who were willing to be doulas with the pregnant mother were trained and then they were used in the study (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Professional doulas were also people who did not have a university education, but only took courses and had a doula certificate. But in Iran, a doula means a Companion midwife who has a university education in midwifery and has also completed courses such as physiological childbirth and childbirth pain relief methods to accompany the mother. Therefore, it is true that she does the work of a doula, but she may be slightly different from a doula due to her knowledge of the birth process and her education, her experiences and understanding, and the challenges that may occur in her interactions. Therefore, it is necessary to check the care process by Companion midwife.\u003c/p\u003e \u003cp\u003eAlso, in Iran, few studies have been conducted on birth attendants, which are mostly focused on the benefits and advantages of using birth attendants (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), which adds to the importance of the research in the present study, but no qualitative study has been conducted in Iran. Also, no qualitative study was found that examines the care process of a doula (Companion midwife). Because in Grand Theory, in addition to interviews, observation is also used to collect data, so it is better to check people's interactions. Also, in the present study, interviews will be conducted with all the people who interact with midwives in some way, such as ward officials, midwives, pregnant mothers and their families, provincial and national officials. Therefore, the researcher decided to investigate the process of care provided by the Companion midwife in Iran by the Grounded Theory. This study is expected to contribute to a better understanding of care by Companion midwife. Because this study will identify the barriers and facilitators of care by Companion midwife in maternity settings. Also, the findings of this study will help the policy makers and national managers to implement the mother-in-law program, which, in addition to benefiting mothers from the benefits of continuous support, will also lead to the improvement of natural childbirth and childbirth.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eWHO\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMAXQDA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eQualitative Data Analysis Software\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUK\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited Kingdom\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe project with the code 4020618 has been approved by the Research Vice-Chancellor of Mashhad University of Medical Sciences, Faculty of Nursing and Midwifery, Research Center for Nursing and Midwifery Care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBefore conducting the interview, written permission will be obtained from all the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMashhad University of Medical Sciences\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNS: Writing a proposal, sampling and conducting interviews, analyzing data, writing an article\u003c/p\u003e\n\u003cp\u003eSE: Ground theory consultant, method review\u003c/p\u003e\n\u003cp\u003eLH: Cooperation in the implementation of the proposal\u003c/p\u003e\n\u003cp\u003eNJ: Final check of the proposal, supervision of work implementation, Final review of the article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to thank the Research Vice-Chancellor of Mashhad University, Nursing and Midwifery Care Research Center for their cooperation in the implementation of this project. I also thank in advance all the participants, whom I will interview.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eArmanmehr V, Banafshe E, Hashemizadeh H, Alami A, Khajavi A. Midwives\u0026rsquo; Perception Regarding Conditions Influencing the Implementation of the Natural Childbirth Promotion Program in Iran: A Qualitative Study. International Journal of Community Based Nursing and Midwifery. 2023;11(2):135-148. doi: 10.30476/IJCBNM.2023.97165.2169\u003c/li\u003e\n\u003cli\u003eKnocke K, Chappel A, Sugar S, De Lew N, Sommers BD. Doula Care and Maternal Health: An Evidence Review.\u003c/li\u003e\n\u003cli\u003eGilliland AL. After praise and encouragement: Emotional support strategies used by birth doulas in the USA and Canada. Midwifery. 2011;27(4):525-31. https://doi.org/10.1016/j.midw.2010.04.006.\u003c/li\u003e\n\u003cli\u003eFernandes LM, Mishkin KE, Lansky S. 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The role of doulas in enhancing patient-provider communication: Southern Illinois University at Edwardsville; 2015. https://www.proquest.com/dissertations-theses/role-doulas-enhancing-patient-provider/docview/1728327221/se-2.\u003c/li\u003e\n\u003cli\u003eLundgren I. Swedish women\u0026apos;s experiences of doula support during childbirth. Midwifery. 2010;26(2):173-80. https://doi.org/10.1016/j.midw.2008.05.002.\u003c/li\u003e\n\u003cli\u003eKatarzyna W-B, Paulina P, Urszula T-P, Beata S, Maria W, Beata P, et al. Cooperation between midwives and doulas in the context of perinatal care-a integrative review of qualitative and quantitative studies. Midwifery. 2023:103731. https://doi.org/10.1016/j.midw.2023.103731.\u003c/li\u003e\n\u003cli\u003eCampbell DA, Lake MF, Falk M, Backstrand JR. A randomized control trial of continuous support in labor by a lay doula. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN. 2006;35.64-456:(4). https://doi.org/10.1111/j.1552-6909.2006.00067.x.\u003c/li\u003e\n\u003cli\u003eOrganization WH. Companion of choice during labour and childbirth for improved quality of care: evidence-to-action brief, 2020. World Health Organization; 2020. \u003cu\u003ehttps://iris.who.int/bitstream/handle/10665/334151/WHO-SRH-20.13-eng.pdf.\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003ehttp://irmidwifery.com/wp-content/uploads/2021/10/4_5823522972412937019.pdf.\u003c/li\u003e\n\u003cli\u003eKhavandizadeh Aghdam S, Kazemzadeh R, Nikjoo R. The Effect of the Doula support During Labor on Delivery Length In Primigravida Women. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2015;18(150):8-13. 10.22038/IJOGI.2015.4574.\u003c/li\u003e\n\u003cli\u003eRezaie M, Dakhesh S, Parpuchi SF. Evaluation of the Relationship between the Attendance of a Companion Midwife and Maternal and Neonatal Consequences. 2021. \u003cu\u003eURL: http://sjnmp.muk.ac.ir/article-1-346-fa.html.\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eKhodabakhshi-koolaee A, Rooshani Koosha F, Mosalanejad L. Effect of an Accompanying Midwife on Maternal Resilience and Preferred Route of Delivery in Pregnant Women. Journal of Clinical and Basic Research. 2019;3(4):7-12. URL: http://jcbr.goums.ac.ir/article-1-229-en.html.\u003c/li\u003e\n\u003cli\u003eScott KD, Berkowitz G, Klaus M. A comparison of intermittent and continuous support during labor: a meta-analysis. American Journal of Obstetrics and Gynecology. 1999;180(5):1054-9. https://doi.org/10.1016/S0002-9378(99)70594-6.\u003c/li\u003e\n\u003cli\u003eLandry SH, McGrath S, Kennell JH, Martin S, Steelman L. The Effect of Doula Support During Labor on Mother-Infant Interaction at 2 Months\u0026bull; 62. Pediatric Research. 1998;43(4):13. https://doi.org/10.1203/00006450-199804001-00083.\u003c/li\u003e\n\u003cli\u003eAmin A, Vadivala R. Labor companionship: A concept of doula care. Journal of Asian Midwives (JAM). 2018;5(2):24-32. https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1099\u0026amp;context=jam.\u003c/li\u003e\n\u003cli\u003eAhlemeyer J, Mahon S. Doulas for childbearing women. MCN The American journal of maternal child nursing. 2015;40(2):122-7. DOI: 10.1097/NMC.0000000000000111.\u003c/li\u003e\n\u003cli\u003eMcLeish J, Redshaw M. A qualitative study of volunteer doulas working alongside midwives at births in England: Mothers\u0026apos; and doulas\u0026apos; experiences. Midwifery. 2018;56:53-60. https://doi.org/10.1016/j.midw.2017.10.002.\u003c/li\u003e\n\u003cli\u003eAdams C, Curtin-Bowen M. Countervailing powers in the labor room: the doula\u0026ndash;doctor relationship in the United States. Social science \u0026amp; medicine. 2021;285:114296. https://doi.org/10.1016/j.socscimed.2021.114296.\u003c/li\u003e\n\u003cli\u003eWikberg A, Eriksson K. Intercultural caring\u0026ndash;an abductive model. Scandinavian Journal of Caring Sciences. 2008;22(3):485-96. https://doi.org/10.1111/j.1471-6712.2007.00555.x.\u003c/li\u003e\n\u003cli\u003eThomas M-P, Ammann G, Brazier E, Noyes P, Maybank A. Doula services within a healthy start program: increasing access for an underserved population. Maternal and child health journal. 2017;21:59-64. https://doi.org/10.1007/s10995-017-2402-0.\u003c/li\u003e\n\u003cli\u003eDevane D, Barrett N, Gallen A, O\u0026rsquo;Reilly MF, Nadin M, Conway G, et al. Identifying and prioritising midwifery care process metrics and indicators: a Delphi survey and stakeholder consensus process. BMC pregnancy and childbirth. 2019;19:1-11.\u003c/li\u003e\n\u003cli\u003eService RW. Book Review: Corbin, J., \u0026amp; Strauss, A.(2008). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory . Thousand Oaks, CA: Sage. Organizational Research Methods. 2009;12(3):614-7. \u003cbr\u003ehttps://doi.org/10.1177/1094428108324514.\u003c/li\u003e\n\u003cli\u003eMunhall PL. Language and nursing research: The evolution. Nursing research: A qualitative perspective. 2007:37-69.\u003c/li\u003e\n\u003cli\u003eSanger J, Sanger J. The Compleat Observer?: A Field Research Guide to Observation: Taylor \u0026amp; Francis; 2002. file:///C:/Users/soltanin4011/Downloads/10.4324_9780203454107_previewpdf.pdf.\u003c/li\u003e\n\u003cli\u003eCorbin J, Strauss A. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory (4th ed.): Thousand Oaks, CA: Sage publications; 2015.\u003c/li\u003e\n\u003cli\u003eLincoln YS, Guba EG. Naturalistic inquiry (vol. 75). Sage Thousand Oaks, CA; 1985.\u003c/li\u003e\n\u003cli\u003eConnelly LM. Trustworthiness in qualitative research. Medsurg nursing. 2016;25(6):435.\u003c/li\u003e\n\u003cli\u003eCorbin J, Strauss A. Basics of Qualitative Research (3rd ed.): Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, California2008. Available from: https://methods.sagepub.com/book/basics-of-qualitative-research.\u003c/li\u003e\n\u003cli\u003eHaugaard A, Tvedte SL, Severinsen MS, Henriksen L. Norwegian multicultural doulas\u0026apos; experiences of supporting newly-arrived migrant women during pregnancy and childbirth: A qualitative study. Sexual \u0026amp; reproductive healthcare : official journal of the Swedish Association of Midwives. 2020;26:100540. https://doi.org/10.1016/j.srhc.2020.100540.\u003c/li\u003e\n\u003cli\u003eStevens J, Dahlen H, Peters K, Jackson D. Midwives\u0026rsquo; and doulas\u0026rsquo; perspectives of the role of the doula in Australia: A qualitative study. Midwifery. 2011;27(4):509-16. https://doi.org/10.1016/j.midw.2010.04.002Get rights and content.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"companion midwife, childbirth, care, process","lastPublishedDoi":"10.21203/rs.3.rs-4091442/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4091442/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: The World Health Organization emphasizes the existence of a birth companion in order to improve the care results and satisfaction of mothers in labor and delivery. Due to the fact that the process of care by a companion midwife during childbirth is unknown and the existing challenges are identified, this study will be conducted with the aim of explaining the process of care by companion midwife during childbirth.\u003c/p\u003e\n\u003cp\u003eMethods: It is a qualitative research with a grounded theory approach that the main participants of the study are midwives. Sampling has been started in a Purposive sampling and will continue based on the resulting categories until data saturation in the form of theoretical sampling. Data collection will be done using in-depth semi-structured interviews, field notes and reminders. The Strauss and Corbin 2015 method will be used for data analysis, which includes five steps: Identification of concepts, development of concepts according to their characteristics and dimensions, data analysis for context, bringing the process into the analysis and integration of categories.\u003c/p\u003e\n\u003cp\u003eDiscussion: This study is expected to contribute to a better understanding of care by companion midwives. Because this study will identify the obstacles and facilitators of the implementation of the companion midwifery program in maternity settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical code:\u003c/strong\u003e IR.MUMS.NURSE.REC.1402.130\u003c/p\u003e","manuscriptTitle":"Explaining the process care by companion midwife during childbirth: study protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-20 06:16:05","doi":"10.21203/rs.3.rs-4091442/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a14f3eae-92e6-4f54-80c5-d665b5ab2fda","owner":[],"postedDate":"March 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-22T11:07:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-20 06:16:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4091442","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4091442","identity":"rs-4091442","version":["v1"]},"buildId":"B-jG_2CBjPDmsCi4Wdhf-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}