Mead Marianne M P, Kornbrot Diana
Department of Nursing and Midwifery, University of Hertfordshire, Hatfield, Herts AL10 9AB, UK.
Midwifery. 2004 Mar;20(1):61-71. doi: 10.1016/S0266-6138(03)00054-8.
to test the hypothesis that midwives working in higher intervention units would have a higher perception of risk for the intrapartum care of women suitable for midwifery-led care than midwives working in lower intervention units.
an initial retrospective analysis of the computerised records of 9887 healthy Caucasian women in spontaneous labour enabled the categorisation of 11 units as either 'lower intrapartum intervention' or 'higher intrapartum intervention' units. A survey of the midwives involved in intrapartum care in these 11 units, using standardised scenario questionnaires, was used to investigate midwives' options for intrapartum interventions, their perceptions of intrapartum risk and the accuracy of these perceptions in the light of actual maternity outcomes.
midwives working in maternity units that had a higher level of intervention generally perceived intrapartum risks to be higher than midwives working in lower intervention units. However, midwives generally underestimated the ability of women to progress normally and overestimated the advantages of technological interventions, in particular epidural analgesia.
variations in intrapartum care cannot be solely explained by the characteristics of the women. The influence of the workplace culture plays a significant role in shaping midwives' perceptions of risk, but it seems even more likely that the medicalisation of childbirth has had an influence on midwives' appreciation of intrapartum risks. Intervention rates for low-risk births are often higher than recommended by research. The level of interventions varies across hospitals and higher rates are associated with higher perception of risk by midwives. Attention needs to be given to the influence the workplace plays in shaping midwives' perception of risk; and to the effect of organisational culture on intervention rates.
检验这样一个假设，即在高干预产房工作的助产士，相较于在低干预产房工作的助产士，对适合由助产士主导护理的产妇的产时护理风险有更高的认知。
对9887名自然分娩的健康白人女性的计算机化记录进行初步回顾性分析，据此将11个产房分为“低产时干预”或“高产时干预”产房。使用标准化情景问卷对这11个产房参与产时护理的助产士进行调查，以研究助产士对产时干预的选择、他们对产时风险的认知以及这些认知根据实际产妇结局的准确性。
在干预水平较高的产房工作的助产士，通常比在低干预产房工作的助产士认为产时风险更高。然而，助产士一般低估了女性正常分娩进展的能力，高估了技术干预（尤其是硬膜外镇痛）的优势。
产时护理的差异不能仅由产妇的特征来解释。工作场所文化的影响在塑造助产士的风险认知方面起着重要作用，但分娩的医学化似乎更有可能影响了助产士对产时风险的认识。低风险分娩的干预率往往高于研究建议水平不同医院的干预水平各不相同，较高的干预率与助产士更高的风险认知相关。需要关注工作场所在塑造助产士风险认知方面的影响；以及组织文化对干预率产生的影响。
