Joyce Rachel, Webb R, Peacock Janet
Department of Public Health Sciences, St George's Hospital Medical School, London.
J Obstet Gynaecol. 2002 Nov;22(6):618-25. doi: 10.1080/0144361021000020385.
We performed a cross-sectional study of all Thames maternity units, 1994-96, including 540,834 live and stillbirths. In contrast to recent media speculation, no association of caesarean section rates with midwifery staffing levels was found after adjustment for confounders. The only association with staffing was with levels of junior obstetric staffing, which could be a reflection of less experienced management of labour. Caesarean section rates were also associated positively with the levels of delivery beds, which could be a reflection of the closer monitoring of labour that may result from increased bed availability. Both caesarean section and instrumental vaginal delivery rates were associated with epidural rates, which was expected from the literature. Variations in epidural rates were mainly associated with variations in demographic case-mix, due possibly to patient demand. Demographic case-mix was also associated with instrumental vaginal deliveries but not the caesarean section rate.
我们在1994 - 1996年对泰晤士河地区所有产科单位进行了一项横断面研究，涵盖540,834例活产和死产。与近期媒体猜测相反，在对混杂因素进行调整后，未发现剖宫产率与助产士人员配备水平之间存在关联。与人员配备唯一有关联的是初级产科人员配备水平，这可能反映了产程管理经验不足。剖宫产率还与分娩床位数量呈正相关，这可能反映了由于床位增加而导致对产程的密切监测。剖宫产率和器械助产阴道分娩率均与硬膜外麻醉率有关，这与文献预期一致。硬膜外麻醉率的差异主要与人口统计学病例组合的差异有关，可能是由于患者需求。人口统计学病例组合也与器械助产阴道分娩有关，但与剖宫产率无关。
