This study explored various aspects of improving childbirth preparedness. Maternal health during pregnancy, having an antenatal care plan, improving health literacy, and developing a birth plan were identified as crucial factors for childbirth preparation. Facilitating factors included mental and emotional preparation, support, financial planning, participation in preparation classes, and awareness of the advantages and disadvantages of different childbirth methods. Hindrances included insufficient mental and emotional preparedness, inadequate support, weak antenatal care, information deficiencies, insufficient physical activity, and a lack of a birth plan. This study offers valuable insights for healthcare providers and policymakers to improve maternal and neonatal outcomes.

As mentioned, the findings of the study identified having an antenatal care plan and improving health literacy as crucial factors for enhancing childbirth preparations. A similar qualitative study by Kalisa et al. (2018) in rural Rwanda also recognized the role of receiving antenatal care as a facilitator of BP/CR from the viewpoints of healthcare workers and community members. Community health workers emphasized the importance of sending BP/CR messages through SMS alerts or during social gatherings to improve health literacy. Additionally, family support and health insurance were identified as other facilitators of BP/CR. On the contrary, disrespect and mistreatment of women by healthcare workers during childbirth, along with contradictory health policies such as charging fees for antenatal care and family planning services, as well as imposing fines on women who give birth outside health facilities, posed significant barriers to BP/CR [28]. The study by Kalisa et al. (2018) aligns with the present study regarding antenatal care programs, family support, and the importance of improving health literacy. It is important to note that the present study was conducted in health centers in Tabriz, Iran, where antenatal care is provided free of charge, and the majority of participants had health insurance coverage. As a result, the study did not mention the costs associated with receiving antenatal care or the need for health insurance. Furthermore, since all interviews took place in healthcare centers and hospitals at the participants' request, it is possible that the participants perceived the interviewer as part of the healthcare team, potentially influencing their reluctance to express views on healthcare worker misconduct or disrespect. WHO emphasizes the importance of respectful maternity care (RMC) to ensure a positive childbirth experience for women. Respectful maternity care is a fundamental human right and is essential for improving maternal and newborn health outcomes. The WHO’s recommendations for respectful maternity care include effective communication; respect and dignity; emotional support; informed consent; autonomy; dignity and accountability; and community involvement. By implementing these recommendations, the WHO aims to create a supportive and respectful environment for women during childbirth, ultimately improving maternal and newborn health outcomes [29, 30].

The importance of having an antenatal care plan and birth plan and improving health literacy, particularly raising awareness about danger signs during pregnancy, childbirth, and postpartum, as well as taking necessary action when such signs are observed, were highlighted in another qualitative study that examined the perceptions, experiences, and challenges of a rural Tanzanian community regarding BP/CR. The study's findings indicated that participants recognized the need to prepare for childbirth, attend antenatal clinics, seek hospital treatment for pregnancy and childbirth complications, and rely on family support for practical and financial preparations. They also mentioned relocating closer to hospitals and utilizing traditional herbs to achieve positive outcomes. Negative community attitudes towards unmarried pregnant women and transportation difficulties were identified as specific barriers to childbirth preparation, while poverty was recognized as a challenge. From the participants' perspective, although maternal healthcare is provided free of charge, the presence of informal costs associated with care creates problems for users [31]. The findings of this study are also aligned with the present study in many dimensions, including the antenatal care plan, taking necessary actions in case of pregnancy and childbirth complications, birth plan (financial planning and planning for hospital visits), and family member support. Due to the Islamic nature of Iranian society, unmarried pregnant women are either non-existent or very rare in the community, and there were no such individuals among the participants in this study. Therefore, negative societal attitudes towards unmarried pregnant women were not mentioned as a barrier to childbirth preparation in the present study.

The significance of improving health literacy and utilizing various information sources, including personal and others' experiences, healthcare providers, written resources such as books and the internet, virtual spaces, and social networks, was emphasized by most participants. The findings of a qualitative study on the utilization of social networks by partners of pregnant women for childbirth and parenthood preparation revealed that both close relationships (such as spouses, friends, and family) and less close relationships (such as other future parents) play a fundamental role as a source of social support during the process of childbirth and parenthood preparation. Partners are able to connect with others, share information, obtain reliable information, and prepare for childbirth and parenthood alongside the pregnant woman [32]. Additionally, a randomized controlled trial (RCT) of the pretest-post-test design examined the effect of a specific Android application on the knowledge of pregnant women's husbands about BP/CR. In this study, both the intervention and control groups received antenatal counseling, but only husbands in the intervention group installed the Android application. The application provided information to husbands during pregnancy about gestational age calculation, common complaints during pregnancy, danger signs, fetal growth and development, and pregnancy exercises. During childbirth, it provided information about danger signs, and in the postpartum period, it covered key danger signs in newborns and new mothers, infant care, breastfeeding techniques, and postpartum exercises. Reminders for antenatal and postpartum care were also included. The results indicated that BP/CR scores increased among couples after the intervention, both for participants in the intervention group and the control group. However, husbands who received the application showed a greater mean difference in BP/CR scores compared to those who received only counselling [33]. The findings of these studies align with the present study and support the use of various information resources and the support of husband, family members and others for childbirth preparation.

In the present study, the importance of husband involvement in care during pregnancy, childbirth, and the postpartum period was emphasized by most participants. They highlighted the role of husbands in providing emotional support, actively participating in decision-making, and assisting with birth planning. Consequently, husband support was identified as a facilitator of childbirth preparation. The findings of a qualitative grounded theory study on the involvement of pregnant women's male partners in BP/CR and the factors that enable or hinder their participation indicated that men play a significant role in supporting pregnant women and BP/CR. They assist in maintaining the health of pregnant women, provide financial support, participate in the decision-making process during treatment, arrange transportation, and facilitate the admission process to the hospital for pregnant women [34]. Similarly, the findings of another qualitative study conducted in the town of Arba Minch, located in southern Ethiopia, revealed that husbands actively participated in BP/CR program by fulfilling various roles. These roles included identifying the appropriate place for delivery, coordinating with a skilled birth attendant, recognizing signs of labor, obtaining accurate information about the due date, providing essential items such as food and clean clothes for both the baby and mother, acting as a personal companion, being knowledgeable about emergency conditions, responding promptly, saving money for emergencies, and identifying decision-makers in case of emergencies [35]. The findings of these studies align with the results of the present study, emphasizing the importance of having a birth plan, promoting health literacy, and involving husbands in the care process.

From the perspective of pregnant and postpartum mothers, factors such as lack of mental and emotional preparedness, lack of information, stress and fear regarding the natural childbirth process and its potential complications, limited support resources, inadequate antenatal care, and lack of a birth plan were identified as barriers of childbirth preparation. The findings of a systematic review (SR) on the factors influencing the implementation of BP/CR interventions revealed that adherence to traditional and incorrect beliefs by women and their families, scarcity of resources (including human resources), financial constraints for women and families, and a mismatch between the provided maternity care services and the desired services of mothers are significant barriers to childbirth preparation. The researchers of this study proposed that simultaneous access to skilled birth attendants across all levels of society and increased formal education for women could serve as facilitators of childbirth preparation [15]. The findings of this systematic review (SR) align with the perspectives of the mothers who participated in this study and highlight the importance of antenatal care and health literacy in improving childbirth preparation. Additionally, the study revealed the presence of weaknesses in care programs, financial challenges, and incorrect beliefs as barriers to effective childbirth preparation. The finding of a qualitative study on childbirth preparation from the perspectives of 36-40 week primiparous women, labor companions, and care providers in Lilongwe, Malawi indicated that primiparous women's lack of childbirth preparation stemmed from fear of the childbirth experience and uncertainty about pregnancy outcomes, ineffective traditional counseling, and inadequate antenatal education. Primiparous women exposed to traditional childbirth guidance rather than skilled care providers experienced childbirth fear and lacked adequate psychosocial childbirth preparation. Additionally, the study findings revealed that while labor companions may exacerbate childbirth stress, they also serve as crucial psychosocial support resources for primiparous women [36]. The findings of the aforementioned study align with the present study in identifying pregnant women's fear of childbirth and their information deficit as barriers to childbirth preparation and recommending the use of the mother's preferred labor companion.

The majority of the themes extracted from the present study align with and support the findings of the aforementioned studies. Exceptions include pregnancy health considerations and participation in childbirth preparation classes, which have not been mentioned in similar studies. Given that most studies examining childbirth preparation have been conducted in low- and middle-income countries, their findings emphasize the basic requirements for childbirth preparation, including improving family education and enhancing access to affordable antenatal care and skilled birth attendants. However, the present study was conducted in Iran, where the basic requirements for childbirth preparation are available to pregnant women, and the prevailing culture also places a strong emphasis on women's health during pregnancy, childbirth, and the postpartum period. For these reasons, the mothers participating in this study emphasized health considerations during pregnancy to improve childbirth preparation. In line with this, various studies have confirmed the impact of improved maternal nutrition [37], increased physical activity [38, 39], genital hygiene practices [40], oral hygiene [41, 42], and emotional well-being [43] on improving pregnancy and childbirth outcomes. Additionally, mothers mentioned participation in childbirth preparation classes, which have been offered by the Iranian Ministry of Health, and Medical Education since 2008, as a facilitator of childbirth preparation. Studies have shown that pregnant women's participation in these courses leads to improved lifestyle during pregnancy, childbirth, and the postpartum period [44]; increased positive experiences during pregnancy [45]; reduced stress and anxiety [46]; decreased fear of childbirth [47]; achieving a positive mindset towards labor pain; better involvement in the childbirth process; improved decision-making by correcting misconceptions; increased self-confidence; awareness of childbirth options; and reduced need for pain relief during childbirth [48].