硬膜外麻醉和分娩镇痛仪行无痛分娩的临床观察

目的探讨硬膜外麻醉和分娩镇痛仪的无痛分娩效果及对分娩方式和母婴健康的影响。方法随机抽取50例行硬膜外麻醉无痛分娩病例为A组,采用L2-L3穿刺,向头侧置管3—4cm,采用负荷量＋持续背景剂量＋患者自控硬膜外镇痛（PCEA）的给药模式;另50例镇痛仪镇痛分娩为B组。结果A组镇痛效果明显;平均宫口开全时间短,宫缩被抑制比例较高需缩宫素加强宫缩。如因某种原因改行剖宫产不需另行置管。但具有创伤性,对麻醉要求高,费用高B组只能在某种程度上缓解疼痛,不能达到完全无痛,产妇仍有宫缩感及宫缩痛,但多数VAS评分〈5,产程干预相对较少,产妇在第二产程可以主动屏气用力,显著降低阴道助产率。结论两者均有效缩短第一产程,对母婴安全;硬膜外无痛分娩较分娩镇痛仪镇痛效果显著,但阴道助产率及缩宫素干扰率也较高。     

使用分娩球促进自然分娩的临床研究

目的研究分析分娩球对促进自然分娩的临床效果。方法选取我院收治162例临产产妇临床资料进行分析。结果观察组在疼痛缓解程度、阴道顺产率、第一产程、总产程时间及产后阴道流血量、新生儿Apgar明显优于对照组（P〈0.05）。结论分娩球可有效促进产妇自然分娩,降低剖宫产率,缓解疼痛,降低新生儿窒息率,值得推广应用。     

国际母婴友好行动的发展过程及对我国的启示

文章通过描述国际母婴友好行动的发展历程,简述了其发展经历了3个阶段,并且提出了在我国进行母婴友好行动的必要性和可行性,为我国推行母婴友好行动提供了建议和理论基础。     

正念分娩疗法对孕妇焦虑抑郁情绪的影响

目的探究正念分娩疗法对孕妇焦虑抑郁情绪的影响,以期为孕妇的心理干预提供参考。方法选择2018年10月-2019年3月在绵阳市第三人民医院产科就诊、符合《精神障碍诊断与统计手册(第5版)》(DSM-5)轻中度焦虑和抑郁诊断标准的孕妇80例,采用随机数字表法分为对照组和试验组各40例,两组均接受常规的心理健康教育,试验组在此基础上接受每周1次、共8次的正念分娩训练。于干预前和干预后,使用患者健康问卷抑郁量表(PHQ-9)和广泛性焦虑量表(GAD-7)对孕妇进行评定。结果干预前后,试验组PHQ-9评分[(6.95±1.40)分vs.(2.10±1.34)分,P0.05]、GAD-7评分[(7.23±1.29)分vs.(2.08±1.51)分,P0.05]差异均有统计学意义,对照组PHQ-9评分[(7.00±1.43)分vs.(3.65±1.35)分,P0.05]、GAD-7评分[(7.18±1.57)分vs.(3.38±1.66)分,P0.05]差异均有统计学意义。干预后,试验组PHQ-9评分和GAD-7评分均低于对照组,差异均有统计学意义(t=5.161、3.666,P均0.01)。结论常规心理健康教育联合正念分娩疗法可能有助于缓解孕妇焦虑抑郁情绪,其效果优于单用常规心理健康教育。     

Exploring Contributing Factors to Psychological Traumatic Childbirth from the Perspective of Midwives: A Qualitative Study

PurposeAs midwives witness and attend the whole process of childbirth, they have a better understanding of which factors may cause traumatic childbirth. However, because most of the studies paid their attention on mothers, little is known about psychological birth trauma from the perspective of midwives. This study aims to gain a full understanding of which factors may contribute to psychological traumatic childbirth from the perspective of midwives.MethodsA qualitative research was conducted using in-depth interviews, which involved fourteen midwives from the maternal ward of a tertiary hospital. The interviews were recorded and transcribed, and then, Colaizzi's method was used to analyze the contents of the interviews.ResultsWe proposed four themes and eight subthemes on the influencing factors of psychological traumatic childbirth from the perspective of midwives: low perceived social support (lack of support from family and lack of support from medical staff), hard times (protracted labor in the first stage and futile efforts during the second stage), poor birth outcomes (poor birth outcomes of the mother and poor birth outcomes of the baby), and excruciating pain (unbearable pain of uterine contraction and labor pain was incongruent with the mother's expectations).ConclusionMedical staff should pay attention to psychological traumatic childbirth and its effects, and emphasis on the screening and assessment of birthing women with negative feelings so that their psychological traumatic childbirth can be prevented and decreased.     

Experiential factors associated with childbirth-related fear in Swedish women and men: A population based study

The aim of this study was to investigate and compare experiential factors associated with childbirth-related fear in women and in men. A questionnaire was completed by 410 women and 329 men who prior to the study had had a healthy baby at Umeå university hospital, Sweden. The level of fear was estimated, and twenty-nine statements designed to measure experiences and perceptions connected to childbirth and childbirth-related fear, were subjected to exploratory factor analysis. Factor scores were calculated and differences among women and men with intense and mild/moderate fear were estimated. Intense fear was reported by 23% of the women and 13% of the men. The factor analysis identified four factors explaining 52% of the variance in woman and 50% in men. The factors were named ‘exposedness and inferiority’, ‘communicative difficulties’, ‘norms of harmony’ and ‘insecurity and danger’. The relative order of the factors varied in relation to gender, and in the women, ‘exposedness and inferiority’ had the greatest explanatory power, while this was true for ‘communicative difficulties’ in the men. Most factors were reported to a significantly higher extent by respondents with intense fear. The results are discussed from a gender perspective.     

Examining the Content Validity of the Birthing Unit Design Spatial Evaluation Tool Within a Woman‐Centered Framework

Introduction: The environment for birth influences women in labor. Optimal birthing environments have the potential to facilitate normal labor and birth. The measurement of optimal birth units is currently not possible because there are no tools. An audit tool, the Birth Unit Design Spatial Evaluation Tool (BUDSET), was developed to assess the optimality of birthing environments. The BUDSET is based on 4 domains (fear cascade, facility, aesthetics, support), each comprising design principles that are further differentiated into specific assessable design items. In the process of developing measurement tools, content validity must be established. The aim of this study was to establish the content validity of the BUDSET from the perspective of women and midwives. Methods: This was a mixed‐methods study with a survey assessing agreement with BUDSET items and in‐depth interviews. Survey results were analyzed using an item‐level content validity index and a survey‐level validity index. Interview data were analyzed using a directed content analysis approach. The study was conducted in 2 locations—a major maternity hospital and a midwifery research center, both in Australia. Study participants were 10 women and 2 midwifery academics. Results: The survey revealed that content‐related validity varied according to the BUDSET domain, with the domains of facility and support established as content valid by most participants. The domains of the fear cascade and aesthetic were less strong, particularly among pregnant women. Interview data analysis provided content validity evidence of both the fear cascade and aesthetic domains. A further 4 subthemes of fear cascade also were identified: foreign space, medical‐hospital‐emergency, being sterile/clinical, and protecting the woman from the environment. Content validity evidence for facility and support domains also was established. Discussion: This study has established that the BUDSET is content valid for assessing the optimality of birthing environments. Some further refinement of the tool is now possible.     

间苯三酚联合分娩镇痛导乐仪在促进自然分娩中应用的临床观察

目的：探讨间苯三酚与导乐仪联合应用在促进自然分娩中的效果。方法选择2012-10至2013-09在我院拟进行阴道分娩的足月妊娠孕妇,对愿意选择镇痛分娩者随机分为联合组、导乐仪组、间苯三酚组,每组160例,不愿意镇痛分娩者作为传统组（ n＝100）。联合组采用间苯三酚与导乐仪联合应用,导乐仪组选取导乐仪镇痛分娩,间苯三酚组应用间苯三酚药物干预,传统组为传统待产不施加任何干预措施。观察四组孕妇的产程变化、分娩结局、对分娩痛的反应等指标。结果联合组、导乐仪组镇痛有效率分别为96．88％和95．63％,均明显优于其他2组（P＜0．05）;联合组宫口扩张速度较其他3组快（P＜0．05）,第一产程、第二产程、总产程短于其他3组（P＜0．05）,剖宫产率为6．25％,明显低于其他3组（P＜0．05）。结论间苯三酚与导乐仪联合应用安全、有效,利于自然分娩,值得推广使用。     

Swaziland rural maternal care: Ethnography of the interface of custom and biomedicine

A retrospective ethnographic enquiry was used to examine the values and beliefs that underpin Swazi women's birth practices during pregnancy, labour, birth and the postnatal period. An unstructured interview guide was used to conduct 15 one-to-one audio-taped interviews in the field. Results revealed that although Swazi women embraced modern biomedical practices, they also largely adhered to customary practices, including use of traditional model of causation of illness, and the use of traditional medicines during childbirth. Recommendations include parallel antenatal education, which gives credence to the customs within the context of scientific modernity. In addition, changes are needed to public health policy that allows parallel systems of care to be delivered within the context of community midwifery practice.