de Jonge Ank, Rijnders Marlies E B, van Diem Mariet Th, Scheepers Peer L H, Lagro-Janssen Antoine L M
Department of General Practice, Women Studies Medicine, University Medical Centre St Radboud, Nijmegen, The Netherlands.
Midwifery. 2009 Aug;25(4):439-48. doi: 10.1016/j.midw.2007.07.013. Epub 2007 Dec 21.
to establish which factors are associated with birthing positions throughout the second stage of labour and at the time of birth.
retrospective cohort study.
primary care midwifery practices in the Netherlands.
665 low-risk women who received midwife-led care.
a postal questionnaire was sent to women 3-4 years after birth. The number of women who remained in the supine position throughout the second stage varied between midwifery practices, ranging from 31.3% to 95.9% (p<0.001). The majority of women pushed and gave birth in the supine position. For positions used throughout the second stage of labour, a stepwise forward logistic regression analysis was used to examine effects controlled for other factors. Women aged 36 years and highly educated women were less likely to use the supine pushing position alone [odds ratio (OR) 0.54, 95% confidence intervals (CI) 0.31-0.94; OR 0.40, 95% CI 0.21-0.73, respectively]. Women who pushed for longer than 60 minutes and who were referred during the second stage of labour were also less likely to use the supine position alone (OR 0.32, 95% CI 0.16-0.64; OR 0.44, 95% CI 0.23-0.86, respectively). Bivariate analyses were conducted for effects on position at the time of birth. Age 36 years, higher education and homebirth were associated with giving birth in a non-supine position.
the finding that highly educated and older women were more likely to use non-supine birthing positions suggests inequalities in position choice. Although the Dutch maternity care system empowers women to choose their own place of birth, many may not be encouraged to make choices in birthing positions.
education of women, midwives, obstetricians and perhaps the public in general is necessary to make alternatives to the supine position a logical option for all women. Future studies need to establish midwife, clinical and other factors that have an effect on women's choice of birthing positions, and identify strategies that empower women to make their own choices.
确定在分娩第二阶段及分娩时，哪些因素与分娩姿势相关。
回顾性队列研究。
荷兰的初级护理助产实践机构。
665名接受助产士主导护理的低风险女性。
在产后3至4年向这些女性发送了一份邮政问卷。在第二阶段始终保持仰卧姿势的女性数量在不同助产实践机构中有所不同，范围从31.3%至95.9%（p<0.001）。大多数女性在仰卧姿势下用力并分娩。对于分娩第二阶段所采用的姿势，采用逐步向前逻辑回归分析来检验在控制其他因素后的影响。36岁及以上的女性和受过高等教育的女性单独采用仰卧用力姿势的可能性较小[优势比（OR）分别为0.54，95%置信区间（CI）为0.31 - 0.94；OR为0.40，95% CI为0.21 - 0.73]。用力超过60分钟的女性以及在分娩第二阶段被转诊的女性单独采用仰卧姿势的可能性也较小（OR分别为0.32，95% CI为0.16 - 0.64；OR为0.44，95% CI为0.23 - 0.86）。针对分娩时姿势的影响进行了双变量分析。36岁、高等教育程度和在家分娩与非仰卧姿势分娩相关。
受过高等教育和年龄较大的女性更有可能采用非仰卧分娩姿势这一发现表明在姿势选择上存在不平等。尽管荷兰的产妇护理系统赋予女性选择自己分娩地点的权利，但许多女性可能未被鼓励在分娩姿势上做出选择。
有必要对女性、助产士、产科医生乃至普通公众进行教育，以使非仰卧姿势成为所有女性的合理选择。未来的研究需要确定影响女性分娩姿势选择的助产士、临床及其他因素，并确定能使女性做出自己选择的策略。
