Wolke D, Dave S, Hayes J, Townsend J, Tomlin M
Department of Psychology, University of Hertfordshire, Hatfield, Herts, UK.
Arch Dis Child Fetal Neonatal Ed. 2002 May;86(3):F155-60. doi: 10.1136/fn.86.3.f155.
To determine whether the routine examination of the newborn by a midwife compared with a junior paediatrician (SHO) affects maternal satisfaction with this examination.
Randomised controlled trial: 826 mother and baby pairs in a district general hospital in south east England were randomised to a paediatric SHO or a midwife for the routine newborn examination. Maternal satisfaction with the examination was analysed in relation to intervention group, process, and background variables.
Some 81% of mothers reported that they were satisfied or very satisfied with the newborn examination. Mothers assigned to a midwife were more satisfied with the newborn examination (crude odds ratio (OR) 0.54 (95% confidence interval (CI) 0.39 to 0.75), p < 0.001). However, after provision of health education during the examination, continuity of care provided, and history of miscarriage had been controlled for, status of examiner was no longer related to maternal satisfaction (adjusted OR 0.82 (95% CI 0.57-1.20), NS). The discussion of healthcare issues by the examiner (adjusted OR 0.49 (95% CI 0.34 to 0.70), p < 0.001) and continuity of care (adjusted OR 0.43 (95% CI 0.23 to 0.81), p < 0.01) were both related to enhanced satisfaction, and history of miscarriage (adjusted OR 1.61 (1.08 to 2.40), p < 0.05) was associated with lower maternal satisfaction with the newborn examination. Midwives (61%) were more likely than SHOs (33%) to discuss healthcare issues, such as feeding, sleeping, and skin care.
Mothers were more likely to be satisfied with the newborn examination by a midwife than an SHO because midwives were more likely to discuss healthcare issues during the examination and were able to provide continuity of care. However, midwife examinations according to exclusion criteria agreed with trial midwives excluded half of all newborns, and criteria may have to be reconsidered for practice implementation.
确定由助产士而非初级儿科医生（住院医师）对新生儿进行常规检查是否会影响产妇对该检查的满意度。
随机对照试验：在英格兰东南部一家地区综合医院的826对母婴被随机分配由儿科住院医师或助产士进行常规新生儿检查。分析产妇对检查的满意度与干预组、检查过程及背景变量的关系。
约81%的母亲报告对新生儿检查感到满意或非常满意。被分配给助产士的母亲对新生儿检查更满意（粗比值比（OR）0.54（95%置信区间（CI）0.39至0.75），p<0.001）。然而，在对检查期间提供的健康教育、所提供护理的连续性以及流产史进行控制后，检查者身份与产妇满意度不再相关（调整后OR 0.82（95%CI 0.57 - 1.20），无显著性差异）。检查者对医疗保健问题的讨论（调整后OR 0.49（95%CI 0.34至0.70），p<0.001）和护理的连续性（调整后OR 0.43（95%CI 0.23至0.81），p<0.01）均与更高的满意度相关，而流产史（调整后OR 1.61（1.08至2.40），p<0.05）与产妇对新生儿检查的较低满意度相关。助产士（61%）比住院医师（33%）更有可能讨论诸如喂养、睡眠和皮肤护理等医疗保健问题。
与住院医师相比，母亲对助产士进行的新生儿检查更满意，因为助产士在检查期间更有可能讨论医疗保健问题并能够提供连续护理。然而，根据与试验助产士商定的排除标准，助产士检查排除了所有新生儿中的一半，在实际应用中可能需要重新考虑这些标准。
