Parents' experiences and perceptions of group-based antenatal care in four clinics in Sweden

Background

group-based antenatal care consists of six to nine two-hour sessions in which information is shared and discussed during the first hour and individual examinations are conducted during the second hour. Groups generally consist of six to eight pregnant women. Parent education is built into the programme, which originated in the United States and was introduced in Sweden at the beginning of the year of 2000.

Objective

to investigate parents' experiences of group antenatal care in four different clinics in Sweden.

Method

a qualitative study was conducted using content analysis five group interviews and eleven individual interviews with parents who experienced group-based antenatal care. An interview guide was used.

Settings

the study was set in four antenatal clinics that had offered group-based antenatal care for at least one year. The clinics were located in three different areas of Sweden.

Participants

the participants were women and their partners who had experienced group-based antenatal care during pregnancy. Other criteria for participation were mastery of the Swedish language and having followed the care programme.

Findings

three themes emerged, ‘The care—combining individual physical needs with preparation for parenthood, refers to the context, organisation, and content of care'. Group antenatal care with inbuilt parent education was appreciated, but respondents reported that they felt unprepared for the first few weeks after birth. Their medical needs (for physical assessment and screening) were, however, fulfilled. The theme, ‘The group—a composed recipient of care’, showed the participants role and experience. The role could be passive or active in groups or described as sharers. Groups helped parents normalise their symptoms. The theme, ‘The midwife—a controlling professional’, showed midwives are ignorant of gender issues but, for their medical knowledge, viewed as respectable professionals.

Key conclusions

in the four clinics studied, group-based antenatal care appeared to meet parents' needs for physical assessment and screening. Parents identified that the groups helped them prepare for birth but not for parenthood. The group model created a forum for sharing experiences and helped participants to normalise their pregnancy symptoms.

Implications for practise

the midwife's role in facilitating group-based antenatal care demands new pedagogical strategies and approaches.     

某省助产专职人员现况调查

为每位分娩者提供专业助产服务是持续有效降低孕产妇和新生儿死亡的关键。为全面了解陕西省县级以上医疗机构助产技术的现状,对调查的68份问卷进行整理分析。数据显示：助产专职人员在职教育的缺失。阻碍了其专业水平的提高;产房内医生、助产专职人员职责划分不清,存在安全隐患;助产专职人员工作量大、职业风险高,得到与付出不相匹配。建议卫生行政部门尽快制定助产专职人员管理法律法规,用法律保证“母婴安全”目标的实现。     

站立式待产椅的设计及应用

目的 设计站立式待产椅,并评价其应用效果。方法 站立式待产椅由椅背、抓握部件、椅面、足部嵌槽等7个部分组成。2020年8月—12月,选取杭州市某三级甲等医院产科收住入院的临产后枕后位的100名产妇为研究对象,按随机数字表法分为试验组50名和对照组50名。试验组在助产士的指导下应用站立式待产椅纠正枕后位,对照组运用传统的待产体位变化（侧卧位+侧俯卧位）纠正枕后位,比较两组胎头位置纠正率、分娩方式及不良事件发生率。结果 试验组胎头位置纠正率为86%,高于对照组的56%,差异有统计学意义（P=0.001）。试验组自然分娩率为88%,高于对照组的66%;阴道助产率为4%,低于对照组的16%;剖宫产率为8%,低于对照组的18%,差异有统计学意义（P=0.009）。结论 站立式待产椅可有效纠正产妇枕后位,提高自然分娩率,是一种便利且安全的分娩辅助器械,可改善产妇的分娩体验。     

助产士参与创伤性分娩体验质性研究的Meta整合

目的系统评价助产士参与创伤性分娩体验的质性研究,为促进助产士心理健康及助产学科发展提供参考。方法计算机检索PubMed、CINAHL、Web of Science、Scopus、Embase、SinoMed、中国社会科学引文索引、中国知网、万方和维普数据库关于助产士参与创伤性分娩体验的质性研究,检索时限为建库至2020年12月。采用澳大利亚乔安娜布里格斯研究所质性研究质量评价标准进行文献质量评价,使用汇集性整合方法对结果进行整合。结果共纳入12篇研究,提炼出104个结果,归纳形成了10个类别,综合得出4个整合结果。整合结果1:分娩创伤事件对助产士造成严重的身心及职业影响;整合结果2:助产士会采取不同的策略来应对分娩创伤事件;整合结果3:助产实践中面临多重困境,影响助产士对分娩创伤事件的体验;整合结果4:参与创伤性分娩后,助产士渴望获得心理支持。结论分娩创伤事件会给助产士造成严重影响。助产士应正视负性情绪,学会积极应对;医疗机构应合理配置产科资源,缓解助产实践面临的困境;管理者应重视助产士参与创伤性分娩的体验,提供心理支持,促进助产士的身心健康。     

A qualitative investigation of alcohol use advice during pregnancy: Experiences of Dutch midwives,pregnant women and their partners

Objective

two studies aimed to explore the advice Dutch midwives give and the information Dutch pregnant women and partners of pregnant women receive about alcohol consumption in pregnancy.

Design

study 1 included individual semi-structured interviews with midwives. Study 2 involved focus groups and individual semi-structured interviews with pregnant women and partners. Interview content was based on the I-Change Model.

Setting

study 1 was conducted nation-wide; Study 2 was conducted in the central and southern regions of the Netherlands.

Participants

10 midwives in Study 1; 25 pregnant women and nine partners in Study 2.

Measurements and findings

study 1 showed that midwives intended to advise complete abstinence, although this advice was mostly given when women indicated to consume alcohol. Midwives reported to lack good screening skills and sufficient knowledge about the mechanisms and consequences of antenatal alcohol use and did not involve partners in their alcohol advice. In Study 2, the views of pregnant women and partners were congruent to the findings reported in Study 1. In addition, pregnant women and partners considered midwives as an important source of information on alcohol in pregnancy. Partners were interested in the subject, had a liberal view on antenatal alcohol use and felt ignored by midwives and websites. Pregnant women indicated to receive conflicting alcohol advice from their health professionals.

Key conclusions

midwives' alcohol advice requires improvement with regard to screening, knowledge about mechanisms and consequences of antenatal alcohol use and the involvement of the partners in alcohol advice during pregnancy.

Implications for practice

training should be given to Dutch midwives to increase their screening skills and their alcohol related knowledge to pregnant women. Research is needed to determine how the midwife's alcohol advice to the partner should be framed in order to optimise the partner's involvement concerning alcohol abstinence in pregnancy. More attention to the topic at a national level, for example via mass media campaigns, should also be considered to change views about alcohol use during pregnancy in all stakeholders.     

助产士组连续性护理模式的应用与效果

目的 探讨助产士组连续性护理对围产结局的影响.方法 实验组以分娩的230例产妇为观察组,采用助产士组的产前咨询门诊、孕妇学校,产时责任制陪伴分娩、产后随访的连续性助产服务护理.以236例产妇未采用助产士组连续护理进行对照组.结果 实验组与对照组比较,产妇对医护的依从性、自然分娩率、服务满意度显著提高(P<0.01).结论 助产士组连续性护理提高产科助产的服务质量,使护患关系更融洽,促使其正确应对分娩,消除产妇对分娩的恐惧心理,促进了自然分娩,保障母婴安康.