Walsh Teresa C
School of Nursing and Midwifery, University of Queensland, Ipswich Campus, Qld 4305, Australia.
Midwifery. 2009 Jun;25(3):242-52. doi: 10.1016/j.midw.2007.03.009. Epub 2007 Jul 12.
this study investigated the phenomenon of spontaneous labour contractions becoming less frequent on admission to hospital, which is observed anecdotally but is not evident in the literature. Anxiety in response to hospitalisation has been proposed to be responsible by initiating the biochemical response termed 'fight or flight'.
A non-experimental prospective design and a combination of quantitative and qualitative analysis. Data were collected using self-report labour diaries, postnatal questionnaires and hospital records of labour. Univariate analysis using t-test and chi(2)-test was performed to examine relationships between variables, and content analysis was undertaken on qualitative data regarding reactions to hospitalisation.
hospital and community maternity services provided by a National Health Service hospital in Southern England in 1997.
about 87 women at least 37-week gestation, uncomplicated singleton pregnancy anticipating spontaneous labour with a live fetus.
labour diaries were analysed from 26 births. In three home births and 11 hospital births, labour contractions became more frequent, but in the remaining 12 labours, contractions decreased after admission to hospital. Women whose contractions slowed were not more anxious, but they rarely had cervical dilatation over 5cm and usually assumed a recumbent position in hospital. Artificial rupture of membranes was performed more frequently in these women, they used more pain relief and had a higher incidence of complicated childbirth; however, these differences were not statistically significant.
labour contractions can increase or decrease in frequency following admission to hospital, and the change of frequency may be associated with stage of cervical dilatation and posture rather than anxiety.
routine intervention to speed up labour on the basis of admission observations is called into question, and women should be made aware that slowing of contractions can occur as a normal part of changing the labour environment. Further research is needed to determine the physiological parameters of spontaneous labour and the role of posture in labour progress is needed.
本研究调查了入院时自然分娩宫缩频率降低的现象，该现象虽有轶事报道，但文献中并无明确记载。有观点认为，因住院引发的焦虑通过启动“战斗或逃跑”的生化反应导致了这一现象。
采用非实验性前瞻性设计，并结合定量与定性分析。通过自我报告的分娩日记、产后问卷及分娩医院记录收集数据。使用t检验和卡方检验进行单因素分析，以检验变量之间的关系，并对有关住院反应的定性数据进行内容分析。
1997年英格兰南部一家国民保健服务医院提供的医院及社区产科服务。
约87名妊娠至少37周、单胎妊娠无并发症且预期自然分娩活胎的女性。
分析了26例分娩的分娩日记。在3例家庭分娩和11例医院分娩中，宫缩频率增加，但在其余12例分娩中，入院后宫缩频率降低。宫缩减缓的女性并非更焦虑，但她们宫颈扩张超过5cm的情况较少，且在医院通常采取仰卧位。这些女性人工破膜的频率更高，使用更多止痛措施，分娩并发症发生率也更高；然而，这些差异无统计学意义。
入院后宫缩频率可能增加或降低，频率变化可能与宫颈扩张阶段及姿势有关，而非焦虑。
基于入院观察进行加速分娩的常规干预受到质疑，应让女性意识到宫缩减缓可能是分娩环境改变的正常部分。需要进一步研究以确定自然分娩的生理参数，并明确姿势在分娩进展中的作用。
