上海市闸北区高剖宫产率供方因素定性研究

目的通过对上海市闸北区医护人员进行个人深入访谈以探讨服务提供者知、信、行和医疗制度对剖宫产率的影响。方法采用定性研究中半结构式访谈的方法,对上海市闸北区两所综合医院产科12名不同职称和职位的医生及护士进行个人深入访谈。现场进行录音,并用NVIVO8．0进行分类、归纳分析。结果共访谈接产医院12名医护人员,其中A院和B院各6名．．工作年限最长者30年,是助产士和护士长,最短的2年,是住院医师。12名访谈对象都充分认识到分娩方式对母婴健康的影响,并在产妇要求剖宫产时尽量劝说。有11名访谈对象表示,基本规范地实行上海市卫生局“选择性剖宫产不应安排在节假日、交接班和夜班”的规定,并较为严格地掌握剖宫产指征。所有访谈对象都否认医生会因为收入问题放宽44宫产指征。有10名访谈对象认为医院不会缺乏人手而采用更为省时的剖宫产,但是人力资源缺乏是这两所医院未开展“导乐全程陪伴分娩”和“减痛分娩”的主要原因。所有访谈对象都表示紧张的医患关系导致医生为规避医疗风险而放宽剖宫产指征。结论产科适宜技术项目开展的少,人力资源缺乏、紧张的医患关系及医疗制度是导致剖宫产率上升的主要因素,应积极改善,以增加产妇及家属对产科医生的信任,解除产科医生后顾之忧,更严格掌握剖宫产指征。

Qualitative study of the effect of health service providers and health care system on high cesarean section rate in Zhabei District of Shanghai

Objective To explore the effect of knowledge, belief and behavior of health service providers and health care system on high cesarean section rate by in-depth individual interview among medical and nursing staff. Methods Semi-structured interview in qualitative study was applied to conduct in-depth interview among 12 doctors and nurses with different professional titles and positions in two comprehensive hospitals in Zhabei District of Shanghai. The interview was recorded on spot. NVIVO 8.0 was used for analysis. Results Altogether 12 doctors and nurses （6 in hospital A and 6 in hospital B） were interviewed. The longest working age was 30 years （ midwife and head nurse） and the shortest was 2 years （resident physician）. All interviewees were fully aware of the impact of different delivery modes on health of mothers and their babies. In case of cesarean section asked for by pregnant women, all interviewees could try to persuade them to have natural delivery. Eleven of 12 subjects believed that they could follow the provision of Shanghai Health Bureau and master cesarean section indications strictly. All interviewees denied that doctors would widen indications of cesarean section because of profit. Most interviewees believed that doctors would not apply cesarean section because of manpower deficiency, but insufficiency of human resources was the main reason for ＂continuous support during labor＂ and ＂pain relief services during labor＂ not available in both hospitals. All interviewees believed that avoiding medical risks due to strained doctor-patient relationship led to loosening indications of cesarean section were loosened. Conclusion Insufficiency of human resources and intense doctor-patient relationship are two impact factors of cesarean section rate. Human resource should be strengthened in obstetrical department to promote the development of ＂continuous support during labor＂ and ＂pain relief services during labor＂. Doctor-patient relationship should be improved positively to make obstetricians stick to indications of cesarean section strictly.