Women's expectations of health care providers in the labor and delivery room in the Kurdistan Region of Iraq


  • Aveen Fattah Hajimam Department of Maternity Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq.
  • Hamdia Mirkhan Ahmed Department of Maternity Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq.
  • Kathryne Mishkin Senior Director, Data Science and Mission Strategy at March of Dims.




MCH, Childbirth, Expectation, Behavior, Communication, Health care provider


Background and objective: The World Health Organization recognizes the importance of positive childbirth experience. In Iraq, patient satisfaction during maternity care visits is not routinely collected. This study was aimed to find out the women’s expectation during labor from physicians and midwives and associated factors such as socio-demographic and obstetrical characteristics.

Methods: This cross-sectional study was conducted in Erbil city, located in the Kurdistan region of Iraq. A total of 1,500 women were targeted while they were accompanying another person, including children, to receive health services in Erbil and eventually 1,196 participated in the study. Data were collected through direct interviews after receiving informed oral consent. Participants were asked to describe their expectations for childbirth using an open-ended question. Responses were then grouped and categorized into 20 expectation items based on overlapping themes. Chi-square tests were used to identify associations with key socio-demographic and obstetric characteristics.

Results: Level of expectation was significantly associated with education (illiterate and high education, P = 0.028),residency (suburban, P = 0.003), parity (grand multipara, P = 0.001), satisfaction with care (those satisfied, P <0.001), and satisfaction with provider communication (those satisfied, P <0.001). This study found that positive and calming verbal and non-verbal expressions, environmental control, encouragement of different positions and mobilization, hygiene, promotion of urinary elimination, and instruction on breathing and relaxation are highly expected by parturient women.

Conclusion: Understanding women’s expectations in the delivery room is critical to health care providers in order to make appropriate care plan and support women to have a positive birth experience and to meet expectations.


Metrics Loading ...


Bowling AG, Rowe N, Lambert M, Waddington KR, Mahtani C, Kenten, A, et al. The Measurement of Patients’ Expectations for Health Care: A Review and Psychometric Testing of a Measure of Patients’ Expectations. Health Technology Assessment (Winchester, England). 2012; 16(30):i–xii,1–509. https://doi.org/10.3310/hta16300.

United Nations Children’s Fund. “1- The State of the World’s Children: A Fair Chance for Every Child, 2016.” New York. https://www.unicef.org/.

World Health Organization. “WHO Recommendations Intrapartum Care for a Positive Childbirth.” 2018.

Tunçalp ӦW, Were C, MacLennan OT, Oladapo AM, Gülmezoglu R, Bahl B, et al. Quality of Care for Pregnant Women and Newborns-the WHO Vision. BJOG : An International Journal of Obstetrics and Gynaecology. 2015; 122(8):1045–9. https://doi.org/10.1111/1471-0528.13451.

The Royal College of Midwives. “Evidence Based Guidelines for Midwifery Led-Care in Labour.” 2012 (Accessed June 4, 2021, at https://www.rcm.org.uk/media/2821/evidence-based-midwifery-march-2018.pdf

Jardim D, Danúbia MB, Celina MM, Obstetric Violence in the Daily Routine of Care and Its Characteristics. Revista Latino-Americana de Enfermagem. 2018; e3069–79. https://doi.org/10.1590/1518-8345.2450.3069.

Hajimam AF, Does antenatal programme decrease adverse pregnancy outcome among obese women., DE Momtfort university, leicester. UK.; 2018.

Kukura DB , Elizabeth DF. “Obstetric Violence.” Geo. LJ. 2017; 106:721.

Maxfield D, David G, Audrey L, Holly PK, Daniel FO, Marya GZ. Confronting Safety Gaps across Labor and Delivery Teams. Am J Obstet Gynecol. 2013; 209(5):402–8

Giordano D, Laura A, Marc NE, Elizabeth G, William GL, Patrice AS. Development, Implementation, and Public Reporting of the HCAHPS Survey. Med Care Res Rev. 2010; 67(1):27–37.

Jordan HA, White CJ, Dcarr C. Costs and Benefits of HCAHPS: Final Report.” Cambridge, MA: Abt Associates Inc.; 2015.

Ranard BL, Rachel MW, Tadas AH, Andrew S, Robert JS, Zachary FM, et al. What Can Yelp Teach Us about Measuring Hospital Quality?Health Affairs (Project Hope). 2016; 35(4):697.

Centers for Medicare and Medicaid Services. “Summary of HCAHPS Survey Results.” Baltimore 2014.

Macarayan EK, Anna DG, Svetlana VD, Frederico G, Ephrem TL, Youssoupha N, et al. Assessment of Quality of Primary Care with Facility Surveys: A Descriptive Analysis in Ten Low-Income and Middle-Income Countries.” Lancet Glob Health. 2018; 6(11):e1176–85.

Cicek O, Eylul D, Mete S. Women’s Expectations from Delivery Nurses of Vaginal Birth: A Qualitative Study. Int J Caring Sci. 2018; 11(2):331.

Abdel Gh, Berggren V. Parturient Needs during Labor: Egyptian Women’s Perspective toward Childbirth Experience, a Step toward an Excellence in Clinical Practice. J Basic Appl Sci Res. 2011; 1(12): 2935–43.

Sayed W, Abd ED, Mohammed HS, Abbas AM, Zahran KM. Maternal Satisfaction with Delivery Services at a Tertiary University Hospital in Upper Egypt, Is It Actually Satisfying. Int J Reprod Contracept Obstet Gynecol. 2018; 7(7):2547–52. https://doi.org/http://dx.doi.org/10.18203/2320-1770.ijrcog20182859.

Bhattacharyya D, Sanghita K, Aradhana S, Malvika S, Mousumi G, Pravesh D, et al. Do Women’s Perspectives of Quality of Care during Childbirth Match with Those of Providers? A Qualitative Study in Uttar Pradesh, India.” Glob Health Action. 2018; 11(1):1527971. x


Mocumbi H, Sibone H, Ulf H, Erik L, Charfudin S, Anifa V, et al. Mothers’ Satisfaction with Care during Facility-Based Childbirth: A Cross-Sectional Survey in Southern Mozambique. BMC Pregnancy and Childbirth. 2019; 19(1):303. https://doi.org/10.1186/s12884-019-2449-6.

Lena N, Thorsell T, Wahn EH, Ekström A. “Factors Influencing Positive Birth Experiences of First-Time Mothers.” Edited by Linda Moneyham. Nurs Res Pract. 2013; 349124. https://doi.org/10.1155/2013/349124.

Robinson-Pant A. Literacy and Education for Sustainable Development and Women’s Empowerment. UNESCO Institute for Lifelong Learning; 2014.

Ahmed HM. Role of Verbal and Non-Verbal Communication of Health Care Providers in General Satisfaction with Birth Care: A Cross-Sectional Study in Government Health Settings of Erbil City, Iraq. Reproductive Health. 2020; 17(1):35. https://doi.org/10.1186/s12978-020-0894-3.

Mudiyanse RM, Weerasinghe GSM, Piyasinghe MK, Jayasundara JMH. Patient’s Expectations during Doctor Patient Communication and Doctor’s Perception about Patient’s Expectations in a Tertiary Care Unit in Sri Lanka. Arch Med. 2015; 6(12).

Berhane A, Fikre E. Patient Expectations and Their Satisfaction in the Context of Public Hospitals. Patient Preference and Adherence 2016; 22:1919–28. https://doi.org/10.2147/PPA.S109982.




How to Cite

Fattah Hajimam, A., Mirkhan Ahmed, H. ., & Mishkin, K. . (2023). Women’s expectations of health care providers in the labor and delivery room in the Kurdistan Region of Iraq. Zanco Journal of Medical Sciences (Zanco J Med Sci), 27(1), 42–52. https://doi.org/10.15218/zjms.2023.007



Original Articles