明代助产手法的进步及其评价

明代的助产手法比北宋杨子建《十产论》的内容有了进一步的发展,表现在各种妇产医著对之有比较广泛的记载,疗效也得到医家们比较普遍的承认。更重要的是手法操作过程得到改进,如提出作好术前的准备工作,剪除指甲、香油润手。而且必须对胎儿位置确诊无疑,严格掌握各种手法的适应症,并增加了胎盘剥离手法及碎胎术。这是明代中医产科学中很值得重视的一部分。虽然仍有许多缺陷,但在当时的医疗条件下,不失为一种有效的急救措施。     

Perceptions and experiences of female genital mutilation after immigration to Sweden: An explorative study

AimThe aim of this study is to explore how women from part of the world where female genital mutilation (FGM) is normative perceive and experience FGM after immigrating to Sweden.MethodInterviews were conducted with eight women from Djibouti, Eritrea, Ethiopia and Somalia. The data were analyzed using qualitative content analysis.ResultsThe women’s feelings were ambivalent: though they opposed FGM, on the one hand, because of its negative effects on health, they acknowledged the practice’s positive cultural aspects on the other hand. The themes that emerged from the interviews are the role of FGM in ensuring virginity and protecting a family’s honor, its role in avoiding shame and enhancing purity, social pressure experienced after immigration, an understanding of FGM as a symbol of the country of origin, and support for changing the tradition.ConclusionThese findings indicate that women originating from communities where FGM is normative live in a context in which the practice is viewed as an important aspect of life even after immigration. More research concerning this complex and deeply rooted cultural issue is recommended.     

Reflexivity in midwifery research: the insider/outsider debate

Objective

to explore the challenges of conducting an observational study of postnatal interactions, between midwives and women, when the researcher was a midwife observing in familiar midwifery settings.

Background

participant observation conducted by researchers who are themselves midwives raises questions regarding the influence of ‘identity’ and ‘insider’ knowledge on the conduct of such projects. The insider/outsider status of researchers has been explored in other disciplines, yet this is an area which is underdeveloped in the midwifery literature where few attempts have been made to subject this issue to sustained analysis.

Design

a qualitative study (investigating the provision of breast-feeding support in the first week after birth) provided the opportunity for reflexive exploration of the tensions faced by midwife researchers.

Setting

two maternity units in New South Wales, Australia.

Participants

participants included 40 midwives and 78 breast-feeding women.

Findings

possessing ‘insider’ midwifery knowledge was advantageous in the ‘getting in’ and ‘fitting in’ phases of this research study however unanticipated role ambiguity, and moral and ethical challenges, arose as a result of this ‘insider’ knowledge and status. Prolonged periods of observation challenged the midwife researcher's preconceived ideas and early decisions about the advantages and disadvantages of being an ‘insider’ or an ‘outsider’ in the research setting.

Key conclusions

reflexive analysis of insider/outsider experiences revealed the middle ground which participant observers tend to navigate. Whilst professional insider knowledge and status offered many advantages, especially at the first study setting, some of the inherent embodied, and socially constructed features of the ‘midwife’ observer role, were unanticipated. Cultural competence, in these observational study settings, translated into role ambiguity, and at times, culturally entrenched role expectations.

Implications for practice

midwifery observation of clinical practice, for research, or practice development purposes, requires a degree of juggling of insider knowledge to facilitate observation and analysis. Prior to conducting observations midwives should consider how best to occupy the middle ground between insider and outsider. Within the middle ground the midwife can draw on those aspects of ‘self’ required to negotiate respectful relationships with colleagues, whilst also ensuring the maintenance of an analytical degree of distancing.     

The Continued Care of Pregnant Women Receiving Opiate Substitution Treatment by Midwives

ABSTRACT. Background: The care of pregnant women receiving opiate substitution treatment (OST) is generally provided by a variety of health care professionals. Midwives working in prenatal consultations take part in this continued care and may meet with their patients several times throughout the pregnancy, which can have a tremendous impact on monitoring. The purpose of the study was to determine whether midwives are used to accompanying women taking OST and to determine their level of knowledge and investment in this area. Methods: One hundred fifty-nine midwives working in prenatal consultations in Lille, Roubaix, and Tourcoing received a questionnaire with 21 questions. Results: One hundred ten surveys were collected and analyzed. The majority (103) of the midwives were attending pregnant women taking OST. They were familiar with the effects of heroin on pregnancy but were not familiar with the management of OST. Conclusions: The training of these professionals is important in risk reduction, and they should know the management of OST. All of the midwives requested specific training.     

北京市助产士核心胜任力现状及影响因素的调查研究

目的:了解北京市助产士的核心胜任力现状,并分析其影响因素。方法:采用助产士核心胜任力量表对北京市24家二级以上医院的283名助产士进行横断面调查。结果:助产士核心胜任力总均分为4.02±0.47。其中分娩期保健能力、孕期保健能力和产后保健能力3个方面能力较好,而孕前保健能力、公共卫生保健能力和新生儿保健能力三个方面相对薄弱。多元回归分析发现,助产工作年限、职务、编制是助产士核心胜任力的影响因素(P<0.05)。结论:北京市助产士核心胜任力水平总体较好,但仍有进一步提升的空间,以满足孕产妇及家属日益增长的服务需求,以及助产士工作范畴拓展和助产专业发展的需要。管理者应根据医院自身情况,对不同特征的助产士实施针对性的培训和管理策略,提高助产士的核心胜任力水平。     

Signalling,status and inequities in maternal healthcare use in Punjab,Pakistan

Despite rising uptake of maternal healthcare in Pakistan, inequities persist. To-date, attempts to explain and address these differentials have focused predominantly on increasing awareness, geographic and financial accessibility. However, in a context where 70% of healthcare is private sector provided, it becomes pertinent to consider the value associated with this good. This study examined patterns of maternal healthcare use across socioeconomic groups within a rural community, and the meanings and values attached to this behaviour, to provide new insight into the causes of persistent inequity. A 10-month qualitative study was conducted in rural Punjab, Pakistan in 2010/11. Data were generated using 94 in-depth interviews, 11 focus group discussions and 134 observational sessions. Twenty-one pregnant women were followed longitudinally as case studies. The village was comprised of distinct social groups organised within a caste-based hierarchy. Complex patterns of maternal healthcare use were found, linked not only to material resources but also to the apparent social status associated with particular consumption patterns. The highest social group primarily used free public sector services; their social position ensuring receipt of acceptable care. The richer members of the middle social group used a local private midwife and actively constructed this behaviour as a symbol of wealth and status. Poorer members of this group felt pressure to use the afore-mentioned midwife despite the associated financial burden. The lowest social group lacked financial resources to use private sector services and opted instead to avoid use altogether and, in cases of complications, use public services. Han, Nunes, and Dreze's (2010) model of status consumption offers insight into these unexpected usage patterns. Privatization of healthcare within highly hierarchical societies may be susceptible to status consumption, resulting in unforeseen patterns of use and persistent inequities. To-date these influences have not been widely recognised, but they deserve greater scrutiny by researchers and policy-makers given the persistence of the private sector.     

家庭分娩室助产103例临床研究

综合阐述了２ 组２１３ 例产妇助产过程中可促进胎儿娩出的半卧位分娩式,倾斜角为４０ ～５０ 度的临床意义。母婴共同完成娩出过程中产道、胎儿、肌肉收缩力（ 产力） 的生理功能和改进分娩环境及监护产程、助产、降低产妇分娩期紧张情绪的护理方法。经临床对比研究,结果：家庭分娩组较一般分娩组第二产程（ 胎儿娩出期） 平均缩短１２ 分钟, Ｐ＜ ０ ．０５ 。头位难产率降低１１ ．６６ ％ , Ｐ＜ ０ ．０１ ,相对减少了新生儿窒息率。