Ultrasound guidance of embryo transfer: A role for midwife

ObjectiveEvaluate the role of midwife with no experience in assisting ultrasound guided embryo transfer.MethodsA prospective randomized study comparing results of IVF after ultrasound guided embryo transfer (ET) assisted either by a midwife with no formal training in US, or by a doctor trained to guide. ET procedure was performed on 553 patients undergoing ultrasound guided ET. The number of embryos transferred, the pregnancy rate (PR), the incidence of extrauterine pregnancy, ongoing pregnancy rate, the implantation rate (IR), difficulty of embryo transfer and quality of US assistance were compared among the groups.ResultsNo significant differences were observed between the two groups regarding the number of embryos transferred (2.5 + 0.7 Group A vs 2.4 + 0.8 Group B) implantation rate (15.6% Group A vs 15.2% Group B), pregnancy rate (34.3% Group A vs 36.2% Group B), ongoing pregnancy rate (23.4% Group A vs 23.9% Group B), and rate of extrauterine pregnancies (1.4% Group A vs 1% Group B). Difficult transfers (2.9% Group A vs 3.6% Group B) and unsatisfactory visualization of uterus and catheter (6.2% Group A vs 7.3% Group B) were also similar in both groups of patients.DiscussionHaving an inexperienced nurse or midwife to perform ultrasound guidance during ET does not markedly affect the clinical results compared to using experienced clinicians for this purpose.     

Variabilidad en la tasa de episiotomías y su relación con desgarros perineales graves y morbilidad neonatal

ObjectiveTo determine the variability in the use of episiotomy among midwives and its relation to third and fourth-degree tears, and the impact on neonatal morbidity.MethodA study was conducted on historical groups from a total of 2,366 eutocic births with a single live fetus greater than or equal to 37 weeks gestation and 18 midwives over a three year period (2009, 2010 and 2011) in «Mancha-Centro» Hospital (Alcázar de San Juan).The outcomes variables for this analysis were the incidence of episiotomy, perineal lacerations, and neonatal morbidity.ResultsThe variability in the use of episiotomy ranged from 19.5% to 50.1% among the 18 midwives in the study, with an average rate of 34.9% (824). Grouped at intervals, 22.1% (524) had a rate of ≤ 25%, 26.1% (621) between 26-35%, 38% (898) between 36-44%, and 13.7% (323) a rate of ≥ 45%, with homogeneity between the groups for all the confounding factors.There was no statistical association between higher rates of episotomy and pH of umbilical artery < 7.10, Apgar score after 5 min < 7, and the level of neonatal resuscitation type iii and iv. There was also no relationship between the rate of episiotomy with perineal integrity and third and fourth-degree tears.DiscussionThe variability in the rate of episiotomy is high, and it is not related to the increased presence of third and fourth-degree tears or increased neonatal morbidity. Episiotomy rates should not be greater than 25%, in order to prevent perineal trauma or loss of fetal well-being.     

各国助产人员从事助产服务现状

了解各国助产人员从事助产服务情况及我国助产的政策、执业范围、助产教育,旨在积极倡导助产改革,制定新的助产政策。认为政府应重新认识助产士职能,在循证的基础上改革助产政策,促进中国助产专业的发展和母婴健康。     

Supporting breast-feeding women from the perspective of the midwife: A systematic review of the literature

IntroductionIn 2003 the World Health Organization (WHO) recommended that infants should be fed exclusively with breast milk until the age of six months. However, breast feeding rates remain lower than recommended. The crucial period for breast feeding support is the first two weeks after birth. During this period breast feeding support from the midwife is needed. The aim of this paper is to gain an in-depth understanding of the role of midwives in their support of breast-feeding women, from their own perspective.MethodsTwo researchers independently conducted a systematic and comprehensive literature search. Studies needed an empirical qualitative research design (1), had to focus on the role of the midwife in the support of the breast-feeding woman from the midwife’s perspective (2), and had to be published between January 2005 and December 2014 (3) in order to be included. Language restrictions were English, Dutch, German and French. Eight qualitative research studies were included, using mainly focus group and in-depth interview studies, which were reported in 11 papers representing 231 midwives and 24 maternity nurses. All but one study concerned midwives working in hospital settings. A critical appraisal was performed of each study.FindingsMidwives value breast feeding education and breast feeding support as a significant part of their role as a postnatal midwife. However, the ways in which a midwife approaches and supports the breast-feeding woman vary. We distinguished two perspectives: ‘the midwife as technical expert’ and ‘the midwife as a skilled companion’. The ‘technical expert’ midwife is mainly breast centred, focuses on techniques, uses the hands on approach and sees a woman as a novice. The ‘skilled companion’ midwife is woman centred, focuses on the mother – infant relationship and uses a hands off approach during the breast feeding support.The midwives working in a hospital setting face many barriers when performing breast feeding support, such as time restraints, which makes it difficult for them to carry out their preferred role as a ‘skilled companion’. These barriers can influence the breast feeding support negatively. Supporting factors, such as evidence based breast feeding guidelines, have a positive influence on the breast feeding support.ConclusionOn the basis of findings of a synthesis of qualitative research studies, we conclude that the majority of the midwives provide breast feeding support as a technical expert and a minority as a skilled companion. Midwives prefer to be a skilled companion but face many barriers in their working contexts.     

助产士在各产程中的护理干预及体会

分娩是妇女一个自然、正常、复杂的生理过程。大多数产妇由于缺乏对分娩的直接体验和正确认识,常产生焦虑、恐惧,而这些心理反应可能影响分娩效果,产生不良影响。产程中健康教育、心理护理、有效沟通、适时消除不利因素和体位管理的综合应用,能有效降低疼痛敏感性,提高产妇依从性,促进医患沟通和产程顺利进展,降低难产率,减少医疗纠纷,效果显著,值得推广。     

不同地区助产士共情疲劳现状及其影响因素的研究

目的 调查中国东部、中部、西部地区不同级别医院助产士共情疲劳现状并分析其影响因素。 方法 采用随机抽样法抽取中国东部、中部、西部地区中的12个省份,便利抽取52所不同级别医院,并采用目的抽样法根据纳入排除标准抽取助产士作为研究对象,采用一般资料问卷、共情疲劳量表及社会支持评定量表进行横断面调查,通过多水平统计模型分析助产士共情疲劳的影响因素。 结果 共回收489份问卷,有效问卷477份,有效回收率为97.8%。调查对象共情疲劳各维度得分为共情满意（31.64±6.47）分、职业倦怠（27.87±5.01）分、继发性创伤应激（26.21±5.70）分,其中82.6%的助产士为中度及以上共情疲劳,社会支持水平总得分（37.93±6.44）分,多水平Logistic回归分析结果显示,医院级别、子女情况、地区、是否喜欢工作氛围、经历分娩创伤事件次数、睡眠质量、社会支持程度对助产士共情疲劳程度有影响（P<0.05）。 结论 助产士的共情疲劳程度较重,社会支持水平低、睡眠质量差、工作氛围不和谐、离异或有婴幼儿的助产士共情疲劳程度较严重,西部地区及二级、三级医院助产士共情疲劳程度较重,护理管理者应根据其影响因素,采取有效措施,降低助产士共情疲劳发生率和程度。     

助产士产前门诊对初产妇情绪及满意度的影响

目的探讨助产土产前门诊对初产妇焦虑抑郁情绪和初产妇对门诊助产士提供护理服务态度和方式的满意度的影响。方法应用随机数字表法将2011年12月～2012年12月在本院产科建卡并定期产检的106例正常初产妇分为对照组和观察组，对照组给予常规产前门诊，观察组在对照组基础上给予助产士产前门诊，观察并比较两组初产妇焦虑、抑郁情绪和初产妇对门诊助产士提供护理的服务态度和方式的满意度。结果观察组焦虑、抑郁标准分均明显低于对照组，且观察组初产妇对门诊助产士提供护理的服务态度和方式的满意度明显高于对照组，差异均有统计学意义（P〈0．05）。结论助产土产前门诊能够有效减少初产妇的焦虑及抑郁程度，提高初产妇对门诊助产士提供护理服务态度和方式的满意度。     

改变服务模式 发挥专科特色 提高产科质量

随着社会的发展 ,生物医学模式向生物 -心理 -社会医学模式的逐步转变 ,在医疗服务中尤其是在产科领域中 ,产妇的社会心理需求日益被广大产科医务工作者重视。苏州市妇幼保健院作为苏州市唯一的妇幼保健专科医院 ,近几年来围绕提高产科服务质量 ,满足产妇需要 ,对产科服务模式的改革进行了积极的探索 ,取得了一定的成绩 ,目前已形成了助产士产前与孕妇“结对子”、产时全产程陪伴、产后整体护理和出院免费随访的具有产科特色的全程系列服务 ,努力做到让服务对象得到实惠 ,让社会满意 ,服务模式逐步与国际接轨。至 2 0 0 0年 3月底为止 ,助产士与孕妇“结对子”15 0 0多位 ,全产程陪伴分娩 34 76例 ,出院随访 34 6 7人次。共收到各类病人满意度调查表近 40 0 0份 ,综合满意度达到99.14%。