Green J M, Renfrew M J, Curtis P A
Mother & Infant Research Unit, University of Leeds, 22 Hyde Terrace, Leeds LS2 9LN, UK.
Midwifery. 2000 Sep;16(3):186-96. doi: 10.1054/midw.1999.0208.
To consider how 'continuity of carer' has been defined in the literature and to review the literature on what aspects of continuity matter to women.
Structured literature review.
The first objective was addressed within the context of a review of the organisation of midwifery services in the UK; for the second objective a wider literature was drawn on.
Data were systematically extracted from the identified 'core' studies on the methods used for assessing continuity of carer and on women's satisfaction with periods of care. Continuity of carer was found to be defined in these studies as fewer caregivers, either overall or during pregnancy, or as a known caregiver in labour. Little attention was paid to other possible interpretations of continuity of carer. The literature on what is important to women was found to have used four distinct methods and findings were consistent within methods. Studies comparing women who had and had not had a known carer in labour found no significant differences in satisfaction; those using rankings or ratings found that a known intrapartum carer was a relatively low priority and most of those using open-ended questions found that few women mentioned continuity. In contrast, all studies which asked postnatal women whether a known intrapartum carer was important reported that those who had experienced it said 'yes', while those who had not, generally thought it unimportant.
There has been an emphasis in existing literature on continuity of carer but little attempt to assess continuity or quality of care. Limited definitions of continuity of carer have been used. There is no evidence that women who were cared for in labour by a midwife that they had already met were more satisfied than those who were not. Other aspects of woman-centred care were likely to be more important. Women wanted consistent care from caregivers that they trust, but most did not value continuity of carer for its own sake.
Limited definitions of continuity of carer seem to be becoming ends in themselves. This has particularly been the case with defining continuity as 'having a known carer in labour'. The available evidence does not justify prioritising this definition of continuity--rather the reverse. This is important for both women and midwives since it opens up other possibilities for organising services that put less strain on midwives' lives and may be equally satisfying for both women and midwives.
探讨文献中如何定义“照护者连续性”，并回顾关于连续性的哪些方面对女性重要的文献。
结构化文献综述。
第一个目标是在对英国助产服务组织的综述背景下进行探讨；第二个目标则借鉴了更广泛的文献。
从已确定的“核心”研究中系统提取有关评估照护者连续性的方法以及女性对照护期间满意度的数据。在这些研究中，照护者连续性被定义为总体上或孕期照护者较少，或者是分娩时有熟悉的照护者。对照护者连续性的其他可能解释关注较少。关于对女性重要的因素的文献使用了四种不同方法，且每种方法的研究结果一致。比较分娩时有熟悉照护者和没有熟悉照护者的女性的研究发现，满意度无显著差异；那些使用排名或评分的研究发现，分娩时有熟悉的照护者相对来说不是优先考虑因素，而大多数使用开放式问题的研究发现，很少有女性提及连续性。相比之下，所有询问产后女性熟悉的分娩期照护者是否重要的研究都报告称，有过此类经历的女性表示“重要”，而没有此类经历的女性通常认为不重要。
现有文献强调照护者连续性，但很少尝试评估照护的连续性或质量。使用的照护者连续性定义有限。没有证据表明在分娩时由她们已经认识的助产士照护的女性比没有这种情况的女性更满意。以女性为中心的照护的其他方面可能更重要。女性希望得到她们信任的照护者提供的持续照护，但大多数女性并非出于照护者连续性本身而重视它。
有限的照护者连续性定义似乎本身成了目的。将连续性定义为“分娩时有熟悉的照护者”尤其如此。现有证据无法证明优先考虑这种连续性定义的合理性——恰恰相反。这对女性和助产士都很重要，因为这为组织服务开辟了其他可能性，减轻了助产士的生活压力，对女性和助产士可能同样令人满意。
