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。     

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.     

助产士工作压力源和心理健康状况的调查分析

目的了解助产士工作压力、心理健康状况以及相互关系,探讨改善护理管理、保障助产士心理健康的方法和途径。方法采用护士压力源量表、焦虑自评量表(SAS)以及抑郁自评量表(SDS)对在广州地区7所医院随机抽取的102名助产士进行问卷调查分析。结果助产士压力源主要存在于工作量与工作时间和护理专业方面。助产士的焦虑分值为(44.84±12.18)分,抑郁分值为(52.21±13.27)分,均高于常模,P<0.01。助产士焦虑和抑郁的发生均与护理专业工作、工作量及时间分配、患者护理和管理以及人际关系成正相关,P<0.01,而与工作环境及资源无关。结论缓解助产士工作压力,保障助产士心理健康急待社会的充分重视,特别是卫生行政管理部门,应积极采取有效的措施减轻助产士工作压力。     

An exploration of obese pregnant women’s views of being referred by their midwife to a weight management service

Midwives have previously reported concerns about discussing and referring obese pregnant women to weight management services, with some women stating that this referral can be upsetting. The current study interviewed obese women who had declined a weight management service during pregnancy to explore if it was the referral process that made them decline the service. Fifteen women participated and reported that being informed about and referred to a service by their midwife was acceptable to them. Participants also mentioned they would expect this information from their midwife. No participants reported being upset by this referral.     

Identifying and supporting women with psychosocial issues during the postnatal period: evaluating an educational intervention for midwives using a before-and-after survey

Objective

women experience a range of psychosocial issues during pregnancy, childbirth and the postnatal period. A review of hospital postnatal care in Australia found that many midwives who provide postnatal care find dealing with psychosocial issues a challenge, further complicated by heavy workloads that reduce the opportunity for quality interactions between midwives and women. This study aimed to evaluate an advanced communication skills education package for midwives caring for women during the postnatal period.

Design

a before-and-after survey design was used. Midwives attended seven sessions over a six-month period in 2006 and completed a survey before and after the sessions to evaluate the programme. Surveys included items about communication skills, willingness to change, learning style, and knowledge of and attitudes towards psychosocial issues.

Setting

the programme was implemented at two sites in Victoria, Australia: a tertiary metropolitan referral hospital and a regional hospital.

Participants

25 midwives participated in the study.

Findings

21 of the 25 participating midwives (84%) completed both the pre and post survey. Following the educational intervention, participants were more likely to feel competent at identifying women in an abusive relationship (p=0.002); encouraging women to talk about any psychosocial issues (p=0.02); actively encouraging women to talk about things on their mind (p=0.01); and encouraging women to talk about how they are really feeling (p=0.02). Participants also felt more confident in their knowledge of psychosocial issues (p=0.01) and in supporting women experiencing psychosocial issues in the early postnatal period (p=0.02). Participants were very positive about the programme.

Key conclusions and implications for practice

the advanced communication programme, implemented for the first time in the postnatal setting, increased the self-reported comfort and competency of midwives to identify and care for women with psychosocial issues during the postnatal period. The effect of this approach should now be evaluated in terms of women’s outcomes.     

Chinese midwives' views on a proposed midwife-led normal birth unit

Objective

to investigate and assess Chinese midwives’ views of their roles and ability to practice in a proposed midwife-led normal birth unit (MNBU).

Design

a self-completed questionnaire supplemented with semi-structured telephone interviews. Memos, diaries, correspondence and comments of Chinese collaborators were also accessed.

Setting

six hospitals in Hangzhou, the capital of Zhejiang province.

Participants

143 midwives were contacted and completed the questionnaire survey. Three midwives were subsequently interviewed.

Findings

the response rate was 100%; 86% of midwives supported the development of an MNBU, and 94.4% expressed confidence that they would be able to practice in an MNBU. The study shed new light on: (1) the meaning of an MNBU in the Chinese context; (2) the need for development of an MNBU; (3) role conflicts among midwives, doulas, nurses and obstetricians; (4) professional expertise and tension; and (5) the low status of Chinese midwives.

Conclusion

the proposed MNBU is welcomed by Chinese midwives. Their consensus and confidence show that there is enthusiasm for this project to proceed. However, the Chinese have never thought of MNBU services before. There is a need to develop well-structured philosophy, policy, procedures and outcome measures.

Implications for practice

the findings highlight the importance of an MNBU to re-establish Chinese midwives’ support of physiological childbirth. The extent to which Chinese midwives understand an MNBU could be further explored. The result may provide a possible route to the continuity of midwifery care and support.     

Chinese midwifery: the history and modernity

Aim

to investigate how and why Chinese midwife numbers are dwindling, and to help understand the role of midwives in society in general.

Method

to critically examine Chinese midwifery in three stages: (1) historical literature overview; (2) identification and reinterpretation of Chinese midwifery and its development; (3) placing issues that have arisen within a sociological context (i.e. the modernisation of obstetric technologies and the meaning of modernity).

Findings

no books on the history of Chinese midwifery were found. History was classified into three stages: (1) before 1929, a period of an indigenous model; (2) 1929–1996, the highs and lows of the bio-medical model; (3) after 1996, the demise of Chinese midwives. The issues identified were the legitimacy and professionalisation of Chinese midwives, the meaning of modernity and the reasons for the decline of Chinese midwifery.

Conclusion

no sufficient evidence-based research was conducted to support the recent changes made to Chinese midwifery. The modernisation of maternity care in China took place amid dramatic social and cultural changes within society. As a consequence, midwifery as a profession in China has been marginalised. The modernisation of maternity care has failed to deliver on personal choice, quality of service and professional diversity.

Implications for practice

evidence-based research and the state's responsibility are essential to ensure the quality of maternity care and to protect the interests of women. The state's responsibilities include legislation regarding the role of midwives, code of practice, professional standards, responsibility and accountability in order to make midwifery care a true choice for women.     

CATCH: development of a home-based midwifery intervention to support young pregnant smokers to quit

Objective

to develop, implement and evaluate a supportive midwifery intervention, Community Action on Tobacco for Children's Health (CATCH), to help young pregnant smokers to quit.

Design

action research project funded from April 2002 to June 2005.

Setting and participants

CATCH was based in a single hospital maternity unit in the West of Scotland and targeted a deprived population of pregnant smokers aged 25 years and under. Outreach work was undertaken in the local community and cessation support was provided in women's own homes.

Intervention

CATCH aimed to meet the particular needs of young pregnant women through a tailored, non-judgmental approach. The service was distinctive as it employed a holistic approach to smoking cessation which focused not only on individual choices and motivations, but on the wider life circumstances that may preclude behaviour change.

Measures

internal and external teams collaborated to ensure a comprehensive evaluation, gathering of both process and outcome data. Outcomes (including self-reported and carbon monoxide validated quit status) were assessed by quantitative surveys undertaken at enrolment to the service and at 3- and 12-month follow-up. All those lost to follow-up were assumed to still be smoking. Participants’ views of the service were gathered independently by an external evaluation team, and a detailed qualitative case study, capturing ongoing learning, was undertaken. Data were collected from participants who joined the project over a 16-month period (November 2002–February 2004).

Findings

the study demonstrated a feasible approach to engaging young pregnant smokers to help them quit. Obstetricians and midwives were willing to refer to a service based in their maternity unit run by a specially trained midwife, and users reported a positive experience of the service. Of 152 eligible clients referred within the 16-month period, 79 (52%) joined CATCH. Of those who joined, 18 (22.8%) were self-reported non-smokers at 3 months, of whom 16 (20.3%) were validated as non-smokers using carbon monoxide monitoring. Thirteen (16.5%) clients reported being smoke free at 12 months, of whom 10 (12.7%) were validated as non-smokers at 12 months.

Implications for practice

CATCH suggests that close partnership with the multi-disciplinary maternity team and integration into the maternity system is invaluable for smoking cessation services targeting pregnant women. It points to the benefits of the service being delivered by a trained midwife in clients’ own homes. Flexibility and a non-judgmental approach are essential to engagement. Attention to the context and wider circumstances of clients’ lives and involving friends and family enables clients to focus on their own smoking.