助产士限制性会阴切开临床决策体验的质性研究

目的 探讨助产士限制性会阴切开临床决策的体验及影响因素，以期为助产士临床决策提供依据，促进产妇安全分娩。方法 采用现象学研究方法，以最大差异抽样策略于2021年10月—12月选取江苏省4所医院的13名助产士进行半结构式深度访谈，运用Colaizzi 7步分析法进行归纳、分析并提炼主题。结果 共提炼出3个主题及所属的9个亚主题：临床决策的动机（专业知识的主导、减少分娩损伤的理念、孕产妇的需求及近远期获益、新生儿安全）、决策中的促进因素（同伴的支持与监督、产妇的配合、自我反思成长）、决策中的障碍因素（自主权的受限、创伤事件的干扰）。结论 助产士对限制性会阴切开临床决策是一个复杂多样的过程。助产士在临床实践过程中，需发挥健康促进者和保护者的作用，保证助产服务的安全性和有效性。

A qualitative study on the experience of clinical decision-making for restrictive episiotomy in midwives

Objective To explore the experience and influencing factors of midwife’s clinical decision-making of episiotomy，in order to provide suggestions and bases for midwives’ clinical decision-making and promote safe delivery. Methods Using phenomenological research method and maximum difference sampling，13 midwives were selected from 4 hospitals in Jiangsu Province to conduct semi-structured in-depth interviews from October to December 2021. Colaizzi 7-step analysis method was adopted for inductive analysis and theme extraction. Results A total of 3 themes and 9 sub-themes were extracted. Theme 1：decision-making motivation（dominance of professional knowledge，concept of reducing trauma in childbirth，maternal needs and short-term & long-term benefits，neonatal safety）. Theme 2：promotion in decision-making（peers’ support and supervision，puerpera’s cooperation and self-reflection）. Theme 3：obstacles in decision-making（limitation of autonomy，interference from traumatic events）. Conclusion Clinical decision-making on episiotomy for midwives is a complex and varied process. In clinical practice，midwives need to play the role of health promoter and protector to ensure the safety and effectiveness of midwifery services.