https://doi.org/10.15218/ejnm.2023.16 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article Attitudes of Pregnant Women towards Husband’s Attendance in Delivery Room in Erbil City ABSTRACT Background and Objectives: Pregnancy is a beautiful and challenging time in a woman's life. A pregnant woman needs more care and support from her husband and family dur- ing this time because of physical and hormonal changes in her body. Husbands' attend- ance and support of women during labor can positively affect pregnant women and child’s health. The purpose of this study is to assess women’s attitudes towards the pres- ence of their husbands during labor in Erbil city. Method: A descriptive cross-sectional study was conducted on pregnant women who visited primary health care and Maternity Teaching Hospital in Erbil city. Epi Info 7 was used to determine the sample size which Three hundred participants were the sample of the calculation. Statistical Package for Social Science (SPSS) version 26 was used to ana- lyze and organize the data thorough using frequency, percentage, and chi-square test. Result: The study revealed that 62% of the participants were in the age group 20-30 years old. Most of the women obtained an elementary school certificate, with a percent- age 23.3%. Most of the participants were urban residents, which was 81.3%. Regarding the income of the participants, the result indicated that most of them were in conditions sufficient for daily living, which was about 57.3%. Women expressed a good level of atti- tude towards husbands' attendance in the delivery room 80.3%. Conclusion: This survey illustrated that most pregnant women agreed to the husband's attendance in the delivery room. Pregnant women needed their husbands during labor which is important in their life. Keywords: Pregnant Women; Husband's Attendance; Delivery Room. Mhadasa Farooq Saadi; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq (Correspondence: noorfarooq1994@gmail.com) Tiran Jamil Piro; Department of Midwifery, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. 146 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Received: 25/07/2022 Accepted: 12/09/2022 Published: 30/5/2023 mailto::%20noorfarooq1994@gmail.com?subject=:%20noorfarooq1994@gmail.com https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.16 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article Pregnancy is a huge life transition that ne- cessitates considerable psychological adap- tations, which are frequently linked with worry and stress. A pregnant woman's lack of psychological and emotional adjustment through pregnancy is a risk factor. De- pressed mood during pregnancy, for exam- ple, has been established as a predictor of postpartum depression moods [1]. Child- birth is one of the most worrying events that a pregnant woman undergo in her life [2]. Father’s presence in the delivery room has been characterized as a process of be- havioral and social effort which is for fa- thers to perform more responsible roles in maternity, and care to guarantee the well- being of women and children [3].In patriar- chal societies, male partner involvement becomes extremely necessary if substantial changes in maternal health outcomes are to be made. Men's involvement in mater- nal health care need to focus on raising their awareness of acute obstetric condi- tions and including them in birth prepared- ness and complication readiness (BPCR). Men's presence would enable them to en- courage their wives to seek emergency ob- stetric care early in the pregnancy, and the couple will be better prepared for birth and complications[4].According to the world health organization (WHO) in 2017, More than 295 000 women lost their lives during childbirth and after giving birth[5]. The ma- jority of this mortality 94% occurred in low- resource regions and most of them could have been prevented. Through the prena- tal care concept, the World Health Organi- zation created a birth readiness plan. The plan aims to reduce obstetric delays by en- couraging the use of competent birth attendants, which reduces the risk of prob- lems during labor. Male participation refers to the partner's assistance and cares for the pregnant lady to have a positive preg- nancy result. Men's engagement is critical to the success of maternal health initia- tives[6].Men play a crucial influence in their female partners' pregnancy and birthing safety. Furthermore, men's exclu- sion from maternal and child health (MCH) services fostered the concept that preg- nancy and delivery are primarily female experiences, and that maternity facilities are only for women. According to studies, men are affected crucial partners in im- proving maternal health and lowering ma- ternal and infant mortality throughout pregnancy and delivery[7].The presence of a man during pregnancy and childbirth affects the pregnancy's and delivery out- come. It lowers the risk of preterm birth, low birth weight, fetal growth restraint, and child mortality by reducing harmful maternal health habits. Male participation decreases maternal stress (by providing social, organizational, and financial sup- port), increases prenatal care uptake, con- tributes to the reduction of risk behaviors, and ensures men's involvement in their potential parental positions from an early age, according to epidemiological and physiological proof[8].Husbands are seen by wives as the most crucial source of sup- port throughout pregnancy and labor, and in certain situations, their help is valued higher than that provided by midwives. Support from husbands during labor is conducive to a more positive experience of childbirth, a shorter duration of labor, and a positive attitude toward growing into motherhood. Expectant men can take on one of three roles to help their wives dur- ing labor: coach, teammate, or observer [9]. Male engagement during pregnancy and labor can result in a healthier marital connection and better birth outcomes for the mother and child. Emotional support during labor and deliveries are all exam- ples of a husband's positive involvement [10].This study was designed due to the fact that this topic has not been raised 147 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.16 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article centers in Erbil city according to geograph- ical designations (East, West, North, and South). The inclusion criteria are com- posed of the participants during the preg- nancy period and who were in the birth room. The study was accepted by the Nursing Ethical Committee of Hawler Med- ical University College of Nursing in 7th October 2021number 108, and official au- thorization was acquired from the Ministry of Health's Director of Health in Erbil. Data were collected via a checklist and a ques- tionnaire. The questionnaire consists of 2 parts. Part one includes socio-demographic characteristics and professional back- ground of the pregnant woman and her husband. This part, also, includes infor- mation like (age of pregnant woman, age of husband, level of education of the preg- nant woman and her husband, woman's occupation, husband's occupation, Resi- dence, Income, religion, and the number of the husband's wives). The second part items focused on women’s attitudes to- wards their husbands’ attendance to the delivery room, this part includes 28 items. The descriptive statistics of the partici- pants according to their hospitals were as follows: The majority of the participants were in the teaching maternity hospital. Their percentage scored 41.7%, Malafandy 14%, Nizdar Bamarni 13.0%, Azady 14.6%, and Mohamad Bajalan 16.7%. : For analyz- ing the collected data, Statistical Package for Social Science (SPSS) version 26 was used. The mean and standard divisions were checked to determine the ac- ceptance rate of participants. In addition, the Chi a square test was used to test the association between women's attitudes and socio-demographic characteristics such as age, level of education, occupa- tion, and economic status. The respond- ents' rights and confidentiality were pro- tected throughout the study. They were ensured that their personal information before in Kurdistan. And in Kurdistan, men do not stay with their wives during the childbirth process. Men’s participation in Maternal and Child Health (MCH) care ser- vices is inferior, Due to our culture, reli- gion, and community policy. The limitation laid down by the researcher was Covid-19 outbreak period, Due to the aforemen- tioned reason; the author faced many difficulties in visiting the places to collect the needed data. The consequences of the Covid-19 pandemic, which continues to endanger people every day, caused peo- ple to avoid each other [25]. The objec- tives of the present study were: 1) Explore women’s attitudes towards the presence of their husbands during their labor. 2) To find out the socio-demographic character- istics and obstetrical history such as; age, level of education, economical status, and occupation of pregnant women. 3) To find out the associations between socio- demographic data such as; age, level of education, occupation, and women’s atti- tudes. A quantitative Descriptive Cross-sectional study was applied on pregnant women who visited primary health care centers and Maternity Teaching Hospital in Erbil city. Data were collected by using a non- Probability (Purposive Sample) technique. Epi Info 7 was utilized to extract the sam- ple size from the population which includ- ed 1380 of women. The sample size was calculated via implementing the afore- mentioned method and yielding a 95% confidence level and a 5% margin of error. The Three hundred participants were the output of the calculation. The study was conducted at Maternity Teaching Hospital, Malafandy primary health care centers, Nazdar Bamarny primary health care cen- ters, Azadi primary health care centers, and Mohamad Bajalan primary health care 148 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.16 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article were kept secretly and explained the goals of the study to them. Table 1 Socio-Demographic characteristics (age of women, age of husband, religion, residence, income, and the number of the Husband's wives) of the study samples re- veal that most of the participants aged be- tween 20-30 years old. The percentage was 62% for the women’s age and 58.3% for the ages of their husbands. Also, the study sample reveals that 100% of the participants were of the Muslim reli- gion. Most of the participants were urban residents, which was 81.3%. Regarding the income of the participants, the result indicated that most of them were in conditions sufficient for daily liv- ing, which was about 57.3%. Most hus- bands have only one wife with a percent- age 98.3%. Also, a small part of them was in bigamy conditions, which was about 1.7%. 149 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULTS Table 1 : Socio-demographic characteristics (age of women, age of husband, religion, resi- dence, income, and the number of the Husband's wives) of the study sample Variables F (%) Age of Women Under 20 Years 35 (11.7) 20-30 186 (62) 31-40 68 (22.6) 41-50 11 (3.7) Total 300 (100) Age of Husband Under 20 Years 2 (0.7) 20-30 175 (58.3) 31-40 95 (31.7) 41-50 25 (8.3) 51 and above 3 (1) Total 300 (100) Religion Muslim 300 (100) Residence Rural 56 (18.7) Urban 244 (81.3) Total 300 (100) Income Sufficient For Daily Living 172 (57.3) Insufficient 87 (29) Exceed Need 41 (13.7) Total 300 (100) The Number of The Husband's Wives One Wife 295 (98.3) Bigamy 5 (1.7) Total 300 (100) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.16 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article 150 with a percentage of 23.3%. And most of the husbands were at the intermediate level which was about 24.7%, and at the secondary school level, which was about 24.0%. were unemployed, with a percentage 81.3%. While the majority of husbands were self-employed, this was about 73.7%. Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 2 Socio-demographic characteristics related to the woman's educational level, and their husband's educational level in the study sample. The table also illustrat- ed that most of the women were ob- tained the primary school certificates, Table 3 Socio-demographic characteristics related to the woman's occupation, and their husband's occupation in the study sample, show that the majority of women Table 2: Socio-demographic characteristics related to the woman educational level, and the husband educational level in the study sample Variables F (%) Woman Educational Level Illiterate 22 (7.3) Read and write 2 (0.7) Primary School 70 (23.3) Intermediate 48 (16) Secondary School 57 (19) Institute Graduate 41 (13.7) College Graduate 59 (19.7) Post Graduate 1 (0.3) Total 300 (100) Husband Educational Level Illiterate 20 (6.7) Read and write 1 (0.3) Primary School 55 (18.3) Intermediate 74 (24.7) Secondary School 72 (24) Institute Graduate 23 (7.7) College Graduate 49 (16.3) Post Graduate 6 (2) Total 300 (100) Table 3: Socio-demographic characteristics related to the woman occupation, and the husband occupation in the study sample Variables F (%) Women Occupation Employer 33 (11) Unemployed 244 (81.3) Self-Employer 23 (7.7) Total 300 (100) Husband Occupation Employer 73 (24.3) Unemployed 6 (2) Self-Employer 221 (73.7) Total 300 (100) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.16 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article 151 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 4 Descriptive statistics of items in table 4 related to women’s attitudes to- wards their husband attendance to the de- livery room. illustrated the acceptance rate of participants for all items of part three in the questionnaire related to women’s atti- tudes about husband attendance in the delivery room, which was 28 items. The item which stated (The husband should escort the wife to the hospital for delivery) got the highest score which is the value 2.96 depending on the women's responses. Other items got a high score, as the value 2.91 for the item regarding (The presence of the husband is calming for his pregnant woman). And, the value was 2.86 for these items (It helps women feel their husband's love for them and their fami- ly.), and (If your husband is present in the delivery room you can ask for anything that you want or you need because your husband has good communication). While the item that got the lowest score was (Husband culture affects the women, staff, and delivery procedure) with a value 2.13. Table 4: Descriptive statistics of items related to women’s attitudes about husband attendance in the deliv- ery room Items Disagree Neutral Agree Mean F (%) F (%) F (%) Q1. It is pleasurable if your husband be with you in the most important moments in life such as childbirth. 39 (13) 1 (0.3) 260 (86.7) 2.74 Q2. Your husband can improve your emotional (psychological) and physical activity during childbirth. 26 (8.7) 5 (1.7) 269 (89.7) 2.81 Q3. The Husband increases the women's self-confidence during labor. 23 (7.7) 5 (1.7) 272 (90.7) 2.83 Q4. The woman can explain her pain of delivery with her husband. 90 (30) 3 (1) 207 (69) 2.39 Q5. Husband attendance helps the pregnant woman bear labor pain. 24 (8.8) 3 (1) 273 (91) 2.83 Q6. Prepares your husband to accept his paternal (parental) responsibility. 40 (13.3) 1 (0.3) 259 (86.3) 2.73 Q7. The presence of a husband in the delivery room has a positive effect on women’s feelings. 35 (11.7) 7 (2.3) 258 (86) 2.74 Q8. It strengthens the couple’s relationship. 20 (6.7) 6 (2) 274 (91.3) 2.85 Q9. Husband attendance decreases the mother's anxiety in the delivery room. 30 (10) 10 (3.3) 260 (86.7) 2.77 Q10. It can transfer the husband's anxiety to the mother. 99 (33) 9 (3) 192 (64) 2.31 Q11. It has a positive effect on the father-child relationship. 53 (17.7) 6 (2) 241 (80.3) 2.63 Q12. It Helps women to feel their husband's love for them and their family. 21 (7) 0 (0) 279 (93) 2.86 Q13. It helps the woman to feel that she was not alone dur- ing a difficult time. 23 (7.7) 2 (0.7) 275 (91.7) 2.84 Q14. The presence of the husband is calming for his preg- nant woman. 13 (4.3) 0 (0) 287 (95.7) 2.91 Table 4: Cont. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.16 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article 152 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Items Disagree Neutral Agree Mean F (%) F (%) F (%) Q15. It is unpleasant for the woman that her husband is with her during childbirth. 267 (89) 0 (0) 3 (11) 2.39 Q16. It is not helpful to the woman when the partner is present. 272 (90.7) 0 (0) 28 (9.3) 2.39 Q17. Husband attendance in the delivery room is against Kurdish culture. 220 (73.3) 2 (0.7) 78 (26) 2.21 Q18. Better to replace another person in place of your husband for companionship in the delivery room. 239 (79.7) 2 (0.7) 59 (19.7) 2.25 Q19. The women listening to their husbands effectively during labor. 27 (9) 9 (3) 264 (88) 2.79 Q20. Societies can affect allowing husbands to participate in child- birth and be present during labor. 167 (55.7) 3 (1) 130 (43.3) 2.06 Q21. If your husband is present in the delivery room you can ask for anything that you want or you need (because your husband has good communication). 20 (6.7) 1 (0.3) 279 (93) 2.86 Q22. Husband may make the woman uncomfortable during labor if he has bad behavior. 215 (71.7) 2 (0.7) 83 (27.7) 2.20 Q23. Husband culture affects the women, staff, and delivery pro- cedure. 208 (69.3) 3 (1) 89 (29.7) 2.13 Q24. The presence of the husband during childbirth can also be problematic for the mother because she may feel more inhibited and have a hard time letting go. 230 (76.7) 0 (0) 70 (23.3) 2.24 Q25. The presence of the husband in the delivery room can be traumatic to some of them; such birth trauma can lead to a sub- sequent loss of sexual desire as it may cause a mental block for the husband. 203 (67.7) 9 (3) 88 (29.3) 2.18 Q26. Preparing a husband for childbirth (pregnancy course), al- lows men to get an idea of what the birth will be like, how they can best support their partner, and what do to in case of unfore- seen events. 44 (14.7) 2 (0.7) 254 (84.7) 2.70 Q27. The husband should escort the wife to hospital for delivery. 6 (2) 0 (0) 294 (98) 2.96 Q28. The husband should escort the wife to a delivery room. 42 (14) 0 (0) 258 (86) 2.72 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.16 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article The result demonstrated that there were a significant association in women’s atti- tudes and their age groups (P- Value=0.014),residence (P-Value =0.027) income (P-Value =0.001), and education levels (P-Value =0.001). These values were less than the alpha value (α ≤ 0.05). The results accepted the alternative hypothe- sis, which means that the variable is not independent, and rejected the null hypoth- esis. Also, the result reveals that there were no significant association in women’s attitudes and the women's occupations (P- Value =0.728), where the significance val- ues were more than the alpha value (a ≥ 0.05). The result accepted the null hypoth- esis, which is that the variable was inde- pendent, and rejected the alternative hy- pothesis. Table 5 shows the levels of women’s atti- tudes towards their husband’s attendance in the delivery room. The result of the women’s attitudes was as follows: 88.33% of them had a positive attitude, and 11.67% had a negative attitude. Table 6 shows the association between women’s attitudes and sociodemographic characteristics of the women’s age, wom- an's educational level, women’s occupa- tion, residence, and income. 153 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 5: Overall women’s attitudes about husband attendance in the delivery room Overall Attitude F (%) Posetive 265 (88.33) Negative 35 (11.67) Total 300 (100) Table 6: Statistical differences in women's attitudes regarding the age of women, woman's educational level, women occupation, residence, and income Variables Overall Practices P-Value Never done Sometimes done Done Total Age of Women Under 20 Years 6 21 8 35 0.014 HS 20-30 73 74 39 186 31-40 24 27 17 68 41-50 5 3 3 11 Total 108 125 67 300 Woman Educational Level Illiterate 9 7 6 22 0.001 HS Read And write 1 1 0 2 Primary School 28 25 17 70 Intermediate 17 24 7 48 Secondary School 20 24 13 57 Institute Graduate 11 21 9 41 College Graduate 21 23 15 59 Post Graduate 1 0 0 1 Total 108 125 67 300 Women Occupation Employer 10 14 9 33 0.728 NS Unemployed 86 105 53 244 Self-Employer 12 6 5 23 Total 108 125 67 300 Residence Rural 13 30 13 56 0.027 S Urban 95 95 54 244 Total 108 125 67 300 Income Sufficient For Daily Living 73 61 38 172 ˂0.001 HS Insufficient 20 48 19 87 Exceed Need 15 16 10 41 Total 108 125 67 300 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.16 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article et al., (2018) [15] that The majority of re- spondents were Muslim. These findings differ from earlier research by Adeniran et al., (2015) [19], which found that half of the participants were Muslim. Additionally, these findings are in contrast to another survey conducted in India, where most of the women were Hindu That was done by Diamond-Smithet al., (2016) [17].Moreover, the study shows that most of the study participants were urban resi- dents. These results are consistent with the study conducted in Ethiopia by Teklesi- lasie and Deressa, (2018)[21] who report that most of the participants were from urban areas. Regarding monthly income, the present study reveals that the majority of the participants were in a status of suffi- cient for daily living. This finding does not incompatible with the study done by Tadesse et al., (2018) [4] who, in the Ethio- pian village of Wolaita Sodo, performed research among 608 spouses of expectant and nursing mothers. They found that 381 of the households had an income of more than 1000 Ethiopian birr (45 USD) per month; this income was insufficient for daily life. Also, the present study shows that most women’s husbands had only one wife. This result was similar to the study done by Alharbi et al., (2018)[19] in Ri- yadh, information was gathered from 250 spouses, all of who were chosen randomly from the waiting areas of the delivery rooms. Most of them were Saudis and had just one wife. While these results are simi- lar to the study done by Amogne et al., (2018) [23] in southeast Ethiopia which was the First wives of their husbands. Study findings showed that attitudes to- ward husband attendance in the delivery room were positive in most participants. The result of the study was similar to the study done by Rafat et al., (2016) [14] in Rasht, most of the participants had a posi- tive attitude towards husband attendance The findings of the current study show that the highest percentage of the study sample was in the age group 20-30 years old. These results are almost similar to previous studies that showed that the majority of the participants were be- tween the ages of 24-29, such as a study done by Sokoya et al., (2014)[7]. The pre- sent study also, shows that the highest percentage of the husband's age of the study sample was in the age group be- tween 20-30 years old. These results are in contrast to previous studies, such as a study conducted in AL Zahra hospital in Rasht under the title Couples' attitudes toward husband's attendance in the deliv- ery room among 259 pregnant women and their spouses Rafat et al.,(2016)[11]. The distribution of the sample regarding the women's level of education reveals the majority of the induced groups were primary school graduates this finding was similar to the result of the previous study which had been conducted in Kenya by Kalisa and Malande, (2016)[12] . The present study shows that most of the husbands were at the intermediate level and the secondary school level. The result is inconsistent with the privacy study done by Kakaire et al., (2011)[13] , that their spouses had only a primary level of education respectively. The study's find- ings revealed that the majority of the study sample—housewives—were mostly self-employed. The results of this study are in contrast to those studies which were conducted in Ethiopia by Kahsay et al., (2013) in which 376 husbands whose wives gave birth participated in a cross- sectional survey. The biggest proportions of women and their husbands were farm- ers. The result of the study shows that all participants were Muslim. These results are similar the results of the study which was conducted in Bangladesh by Rahman 154 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. DISCUSSION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.16 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article 155 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. to a subsequent loss of sexual desire as it may cause a mental block for the hus- band. The result of the study was support- ed by Oboro et al.,( 2011)[22] in a qualita- tive cross-sectional study conducted on 197 women in Nigeria, it was found that some pregnant women refused to have their spouse present during labor because of concerns about losing their sexual ap- peal. Besides the study results showed a significant difference in women’s attitudes with age and educational levels. The find- ing of the study was consistent with the previous study done by El-Magrabi and Mohamed, (2012)[23] in Egypt. The study used a quota sample of 200 pregnant women who visited the outpatient prena- tal clinic at the end of the third trimester. The attitude scores were significantly re- lated to age, job, and education. Nejad, (2005) [20] showed that Attitude scores were significantly related to age, job, and education. That was the result of the pre- vious study in agreement with the results of the present study. The present study shows significant differences in women’s attitudes and education levels. The results accepted the alternative hypothesis, which means that the variable is not inde- pendent, and rejected the null hypothesis. This result was similar to the study done by Rafat et al., (2016) [11] in Rasht. That reports a significant relationship between the mother's education level and attitude toward the husband’s attendance in the delivery room. Finally, the findings of the present study show that there were no significant differences in women’s atti- tudes and the women's occupations. The finding of the study is inconsistent with the study done by Agushybana, (2016) [24] in Indonesia. This study found that women's occupations significantly deter- mine complications during pregnancy and childbirth at a significant level. Women with occupations are more likely to be in the delivery room. In a study conducted in Iran by Nejad, (2005)[20] on attitudes of couples about the presence of the spouse in the delivery room during childbirth among 150 couples showed that most women had positive outlooks toward the husband’s presence in the delivery room. which is in agreement with the result of the present study. These results have been supported by Sokoya et al., (2014)[7], who conducted a study on 200 women and found that the majority of participants felt that wives needed their husbands' assis- tance throughout pregnancy, labor, and delivery. The item 27 which states The husband should escort the wife to the hos- pital for delivery) got the highest score depending on the women's responses. These results are in contrast to previous studies, such as a study conducted by Ka- lisa and Malande, (2016) [12] in Kenya, among 350 pregnant women. Another items got a high score, item 14, which fo- cuses on the presence of the husband is calming for his pregnant woman), the find- ing of the study was consistent with the previous study done by Sokoya et al., (2014) [7] At Ogun, among 200 women who were visiting the prenatal and baby welfare clinics of four hospitals were ran- domly given questionnaires with closed- ended items as part of a descriptive survey design. That said their husband's support made pregnancy calming and less stressful for them. And similar to the previous study demonstrating the importance of the husband's participation in labor since his presence in the delivery room can help the mother emotionally. Indeed, the high- est attitude score was for the item “it is calming for the mother.”., which was by Alharbi et al., (2018)[19]. The present study also, showed that some of the wom- en agree that the presence of the husband in the delivery room can be traumatic for some of them; such birth trauma can lead https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.16 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article 156 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. childbirth complications in Mulago Hospi- tal, Uganda. BMC Pregnancy Childbirth. 2014 Jan 31;14(1):54. [9] Ip WY. Relationships between partner’s support during labour and maternal out- comes. Journal of Clinical nursing. 2000 Mar;9(2):265-72. [10] Story WT, Burgard SA, Lori JR, Taleb F, Ali NA, Hoque DE. 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