Green Josephine M, Baston Helen A
Mother and Infant Research Unit, University of Leeds, Leeds, England.
Birth. 2003 Dec;30(4):235-47. doi: 10.1046/j.1523-536x.2003.00253.x.
Many studies have revealed that a sense of control is a major contributing factor to a woman's birth experience and her subsequent well-being. Since not all studies conceptualize "control" in the same way or distinguish between "external" and "internal" control, the purpose of this study is to advance understanding of how these senses of control relate to each other.
Questionnaires were sent to women 1 month before birth to assess their preferences and expectations and at 6 weeks after birth to discover their experiences and assess psychological outcomes. Data are presented from 1146 women. Three control outcomes were considered: feeling in control of what staff do to you, feeling in control of your own behavior, and feeling in control during contractions.
Women were less likely to report being in control of staff (39.5%) than in control of their own behavior (61.0%). Approximately one-fifth of the sample felt in control in all three ways, and another one-fifth did not feel in control in any of them. Parity was strongly associated with feeling in control, with multiparas feeling more in control than primiparas in all cases. In logistic regression analyses, feeling in control of staff was found to relate primarily to being able to get comfortable, feeling treated with respect and as an individual, and perceiving staff as considerate. Feeling in control of one's behavior and during contractions were primarily related to aspects of pain and pain relief, but also to antenatal expectations of control. Worry about labor pain was also an important antenatal predictor for primiparas. All three control outcomes contributed independently to satisfaction, with control of staff being the most significant; relationships with emotional well-being were also demonstrated.
All three types of control were important to women and contributed to psychological outcomes. Internal and external control were predicted by different groups of variables. Caregivers have the potential to make a significant difference to a woman's experience of childbirth. The ways in which women are helped to deal with pain will affect internal control; the extent to which they feel that they are actually cared about, rather than care being something that is done to them, will affect external control. Both contribute to satisfaction and emotional well-being.
许多研究表明，掌控感是影响女性分娩体验及随后幸福感的一个主要因素。由于并非所有研究对“掌控”的概念界定相同，也未区分“外部”和“内部”掌控，本研究的目的是增进对这些掌控感如何相互关联的理解。
在分娩前1个月向女性发放问卷，以评估她们的偏好和期望；在分娩后6周发放问卷，了解她们的经历并评估心理结果。数据来自1146名女性。考虑了三种掌控结果：对医护人员对你所做之事的掌控感、对自身行为的掌控感以及宫缩时的掌控感。
报告对医护人员有掌控感的女性比例（39.5%）低于对自身行为有掌控感的女性比例（61.0%）。约五分之一的样本在所有三种情况下都有掌控感，另有五分之一在任何一种情况下都没有掌控感。产次与掌控感密切相关，在所有情况下经产妇比初产妇更有掌控感。在逻辑回归分析中，发现对医护人员的掌控感主要与能够感到舒适、被尊重对待以及被视为个体，以及认为医护人员体贴周到有关。对自身行为的掌控感和宫缩时的掌控感主要与疼痛及疼痛缓解方面有关，但也与产前的掌控期望有关。对分娩疼痛的担忧也是初产妇重要的产前预测因素。所有三种掌控结果都独立地对满意度有贡献，其中对医护人员的掌控最为显著；还表明了与情绪幸福感的关系。
所有三种类型的掌控对女性都很重要，并有助于心理结果。内部和外部掌控由不同的变量组预测。护理人员有可能对女性的分娩体验产生重大影响。帮助女性应对疼痛的方式将影响内部掌控；她们觉得自己实际得到关心的程度，而非护理只是对她们所做之事，将影响外部掌控。两者都有助于满意度和情绪幸福感。
