营养失调与治疗杂志

抽象的

2019 年新生儿护理大会：台湾女性的决策过程及其对剖腹产后分娩方式的影响：一项定性研究 - 陈淑文 - 护理与健康科学大学

陈淑文

剖宫产后阴道分娩 (VBAC) 是早期剖宫产 (CS) 女性的另一个机会；但由于担心子宫破裂的风险，这种选择受到限制。本研究的目的是探索女性的决策过程以及先前剖宫产对她们分娩方式的影响。研究采用定性方法。研究分为三个阶段。

涉及妊娠33-34周的自然观察。 对妊娠35至37周的孕妇进行采访。 采访对象为产后 1 个月接受采访的同一批女性。

调查在台湾北部的一家私人医疗中心进行。采用立意抽样，招募了21名妇女和9​​名产科医生。数据收集包括深入谈话、观察和现场笔记。数据分析采用持续比较分析。确保母亲和婴儿的安全是妇女决策的重点。妇女的决策影响涉及早期分娩经验、对阴道分娩风险的关注、对分娩方式的评估、当前怀孕情况、信息资源和健康保障。在与产科医生沟通时，一些妇女遵从产科医生对重复剖宫产 (RCS) 的建议，而没有被告知其他替代方案。其他人使用四步决策过程，包括搜索信息、听取产科医生的专业判断、评估替代方案和对分娩方式做出决定。分娩后，妇女在三个方面模仿她们的选择：

• 对生育选择的反思

• 反思影响决策的因素

• 对决策结果的反思

母亲和婴儿的健康和幸福是女性最关心的问题。在回答决策影响时，女性与产科医生在分娩选择方面的联系从被动决策到共同决策各不相同。所有女性都有权了解替代分娩决定。产科医生定期澄清与替代分娩选择相关的风险，以及国家健康保险为 RCS 提供财务保障，将关心女性的决策。建立一个网站为女性提供有关分娩选择的可靠数据也可能有助于女性的决策。

方法：

Using a qualitative approach, the research encompassed three stages.

Stage 1- Involved in the naturalistic opinion of obstetric consultations to know how obstetricians assisted women to make their birth choices. Stages 2- Involved interviews with pregnant women to explore their perceptions of the influences on their preferences for mode of birth. Stage3- Consisted of interviews in the postnatal period with the same women who were interviewed in stage 2. The determination of the stage 3 interview was to capture women’s reflections about the effects on their decisions regarding mode of birth, and the relationship between their choices and the actual birth mode outcome.

The study was conducted in a private, tertiary teaching

medical centre in northern Taiwan. At the hospital, there

were between 350 and 450 births per month and the CS

rate varied between 34% and 38%, consistent with Tai-

wan’s overall CS rates [19]. A purposive sampling ap-

proach was used in this study. Pregnant women who

had undergone a previous CS were eligible to be in-

cluded. Inclusion criteria were: women who were aged

18-45 years of age, fluent in Mandarin or English, 30-

32 weeks’gestation, and had experienced a previous CS.

Exclusion criteria included women with a multiple preg-

nancy, a previous classic CS or myomectomy, and/or

high-risk pregnancies (for example, women who had risk

factors such as threatened premature labour, hyperten-

sion, heart disease, diabetes, epilepsy, or another pre-

existing medical problem)

The study was conducted in a private, tertiary teaching

medical centre in northern Taiwan. At the hospital, there

were between 350 and 450 births per month and the CS

rate varied between 34% and 38%, consistent with Tai-

wan’s overall CS rates [19]. A purposive sampling ap-

proach was used in this study. Pregnant women who

had undergone a previous CS were eligible to be in-

cluded. Inclusion criteria were: women who were aged

18-45 years of age, fluent in Mandarin or English, 30-

32 weeks’gestation, and had experienced a previous CS.

Exclusion criteria included women with a multiple preg-

nancy, a previous classic CS or myomectomy, and/or

high-risk pregnancies (for example, women who had risk

factors such as threatened premature labour, hyperten-

sion, heart disease, diabetes, epilepsy, or another pre-

existing medical problem)

Two interviews of women were conducted to elicit their

perspectives, preferences regarding birth choice before

and birth reflections afterwards. A semi-structured inter-

view guide was used for the interview to cover key issues

for women participants.

Ethics approval was obtained from the university and

hospital Human Research Ethics Committee. Prior to

commencement, participants gave written informed con-

sent for participation and the audio-recording of the in-

terviews. The researcher invited eligible women to

participate in the study when they attended the registra-

tion counter for their prenatal examination at the 33-

34 weeks’gestation visit in the Outpatient Department

of Obstetrics and Gynaecology. Interactions between the

consulting obstetrician and the pregnant woman were

observed and field notes were recorded.

Two interviews of women were conducted to elicit their

perspectives, preferences regarding birth choice before

and birth reflections afterwards. A semi-structured inter-

view guide was used for the interview to cover key issues

for women participants.

Ethics approval was obtained from the university and

hospital Human Research Ethics Committee. Prior to

commencement, participants gave written informed con-

sent for participation and the audio-recording of the in-

terviews. The researcher invited eligible women to

participate in the study when they attended the registra-

tion counter for their prenatal examination at the 33-

34 weeks’gestation visit in the Outpatient Department

of Obstetrics and Gynaecology. Interactions between the

consulting obstetrician and the pregnant woman were

observed and field notes were recorded.

Two interviews of women were showed to elicit their perspectives, preferences concerning birth choice before, and birth reflections afterward. A semi-structured interview guide was used for the interview to cover key issues for women participants. Ethics consent was got from the university and hospital Human Research Ethics Committee. Prior to commencement, participants gave written informed consent for participation and the audio-recording of the interviews. The researcher asked eligible women to share in the study when they joined the registration security for their prenatal examination at the 33- 34 weeks’ gestation stays in the Outpatient Department of Obstetrics and Gynaecology.

会诊产科医生与孕妇之间的联系是体验式的，并记录了现场笔记。与该孕妇的产前访谈安排在该孕妇下次看产科医生时。正确的面对面访谈是在孕妇留在产科医生那里时在妊娠 35-37 周时进行的。在孕妇等待产科医生预约期间，妇产科门诊部安静的候诊室被用来进行访谈。访谈以一个关键问题开始，“你能否告诉我，关于分娩方式，你的分娩计划是什么？”在孩子出生前签署产后访谈协议后，以及出生后约 1 个月，向孕妇发送一条要求进行产后访谈的便携短信，以检查她们是否愿意参加访谈。产后妇女参加完例行产后随访后，在妇产科门诊或新生儿科候诊室进行面对面访谈。共有 24 名孕妇决定参与研究并签署了协议。其中三名妇女被纳入研究，其中两名妇女搬到了台湾南部的另一家医院，一名妇女在产前会诊前流产。总共有 9 名产科医生和 21 名孕妇参与了研究。妇女完成了一份调查问卷，以提供她们的人口统计特征。产科医生和孕妇之间的咨询意见在参与研究的 21 名孕妇中，只有 9 名是在与产科医生咨询期间体验性的。共有 12 名孕妇未被发现，因为她们的产科医生不同意参与研究。当妇女怀孕 33-34 周时，通过妇产科门诊的讨论发现产科医生和孕妇之间的互动。记录观察数据并收集现场笔记。在咨询过程中，妇女很少提问。在大多数讨论中，产科医生为妇女提供常规产前检查，例如检查胎儿心跳和测量子宫底高度。他们没有提供任何有关分娩方式的咨询。平均而言，每次咨询在 5-8 分钟内完成。

注：本研究部分成果于 2019 年 5 月 8 日至 9 日在日本东京举行的第 31^届新生儿护理和产妇保健全球专家会议上发表