Tracy Sally K, Sullivan Elizabeth, Wang Yueping Alex, Black Deborah, Tracy Mark
Australian Institute of Health and Welfare, National Perinatal Statistics Unit, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031, Australia.
Women Birth. 2007 Jun;20(2):41-8. doi: 10.1016/j.wombi.2007.03.005. Epub 2007 Apr 27.
Despite concern over high rates of operative birth in many countries, particularly amongst low risk healthy women, the obstetric antecedents of operative birth are poorly described. We aimed to determine the association between interventions introduced during labour with interventions in the birth process amongst women of low medical risk.
We undertook a population-based descriptive study of all low risk women amongst the 753,895 women who gave birth in Australia during 2000-2002. Adjusted odds ratios (AOR) were calculated using multinomial logistic regression to describe the association between mode of birth and each of four labour intervention subgroups separately for primiparous and multiparous women.
We observed increased rates of operative birth in association with each of the interventions offered during the labour process. For first time mothers the association was particularly strong.
This study underlines the need for better clinical evidence of the effects of epidurals and pharmacological agents introduced in labour. At a population level it demonstrates the magnitude of the fall in rates of unassisted vaginal birth in association with a cascade of interventions in labour and interventions at birth particularly amongst women with no identified risk markers and having their first baby. This information may be useful for women wanting to explore other methods of influencing the course of labour and the management of pain in labour, especially in their endeavour to achieve a normal vaginal birth.
尽管许多国家对剖宫产率居高不下表示担忧，尤其是在低风险健康女性中，但剖宫产的产科相关因素却鲜有描述。我们旨在确定低医疗风险女性在分娩过程中采取的干预措施与分娩过程中的干预措施之间的关联。
我们对2000年至2002年在澳大利亚分娩的753,895名女性中的所有低风险女性进行了一项基于人群的描述性研究。使用多项逻辑回归计算调整后的优势比（AOR），以分别描述初产妇和经产妇的分娩方式与四个分娩干预亚组中每一个之间的关联。
我们观察到，分娩过程中采取的每一项干预措施都与剖宫产率的增加有关。对于初产妇而言，这种关联尤为强烈。
本研究强调需要更好的临床证据来证明分娩时使用硬膜外麻醉和药物的效果。在人群层面，它表明了与分娩过程中的一系列干预措施以及分娩时的干预措施相关的自然阴道分娩率下降的幅度，特别是在没有确定风险标志物且为初产妇的女性中。这些信息可能对想要探索其他影响分娩过程和分娩疼痛管理方法的女性有用，尤其是她们努力实现正常阴道分娩时。
