Spiby H, Henderson B, Slade P, Escott D, Fraser R B
Central Sheffield University Hospitals NHS Trust, England.
J Adv Nurs. 1999 Feb;29(2):388-94. doi: 10.1046/j.1365-2648.1999.00900.x.
There is little evidence to associate attendance at antenatal classes with a reduction in psychological distress or increased satisfaction with the experience of labour. There may be several reasons for this, including failure to implement coping strategies. A within-subjects research design explored the use in labour of coping strategies taught in antenatal classes and the role of practice. Women's views about using these strategies and their expectations of their midwives and birth companions were also identified. Following Ethics Committee approval and providing informed consent, 121 nulliparous women completed a questionnaire at their final antenatal class. This included questions on confidence and the amount of effort required to use coping strategies, the involvement hoped for from birth companions and midwives in using coping strategies in labour and satisfaction with the amount of practice of coping strategies. Within 72 hours of delivery, women were interviewed to obtain a narrative of the events of labour and their use of the coping strategies (sighing-out-slowly breathing, Laura Mitchell relaxation and postural change). A questionnaire obtained information on the involvement of the midwife and birth companion. Women used the three coping strategies to different extents. Midwives were not involved to the extent that women had hoped for antenatally. Birth companions achieved a level of involvement closer to women's hopes than that achieved by midwives. A significant proportion of women expressed dissatisfaction with the amount of practice of coping strategies during antenatal classes. The findings of this study of a group of well-prepared women raise questions about the correct components of antenatal classes and how midwives and birth companions can be involved optimally in this aspect of a woman's labour. Further research is required to determine how women can best be helped to cope with the experience of labour.
几乎没有证据表明参加产前课程能减少心理困扰或提高对分娩体验的满意度。原因可能有多种，包括未能实施应对策略。一项受试者内研究设计探讨了产前课程中教授的应对策略在分娩中的使用情况以及练习的作用。还确定了女性对使用这些策略的看法以及她们对助产士和分娩陪伴者的期望。在获得伦理委员会批准并提供知情同意后，121名未生育过的女性在她们最后一次产前课程时完成了一份问卷。这包括关于信心和使用应对策略所需努力程度的问题、希望分娩陪伴者和助产士在分娩中使用应对策略的参与程度以及对应对策略练习量的满意度。在分娩后72小时内，对女性进行了访谈，以获取她们对分娩过程及应对策略使用情况的描述（缓慢呼气、劳拉·米切尔放松法和姿势改变）。一份问卷获取了关于助产士和分娩陪伴者参与情况的信息。女性对这三种应对策略的使用程度各不相同。助产士的参与程度未达到女性产前的期望。分娩陪伴者的参与程度比助产士更接近女性的期望。相当一部分女性对产前课程中应对策略的练习量表示不满。这项对一组准备充分的女性的研究结果引发了关于产前课程正确组成部分以及助产士和分娩陪伴者如何能在女性分娩这一方面实现最佳参与的问题。需要进一步研究以确定如何能最好地帮助女性应对分娩体验。
