Behruzi Roxana, Hatem Marie, Goulet Lise, Fraser William, Leduc Nicole, Misago Chizuru
Department of Social and Preventive Medicine, Université de Montréal, 1420 Boul Mont-Royal, Montréal, QC H2V4Q3, Canada.
Med Health Care Philos. 2010 Feb;13(1):49-58. doi: 10.1007/s11019-009-9220-0. Epub 2009 Aug 11.
The medical model of childbearing assumes that a pregnancy always has the potential to turn into a risky procedure. In order to advocate humanized birth in high risk pregnancy, an important step involves the enlightenment of the professional's preconceptions on humanized birth in such a situation. The goal of this paper is to identify the professionals' perception of the potential obstacles and facilitating factors for the implementation of humanized care in high risk pregnancies. Twenty-one midwives, obstetricians, and health administrator professionals from the clinical and academic fields were interviewed in nine different sites in Japan from June through August 2008. The interviews were audio taped, and transcribed with the participants' consent. Data was subsequently analyzed using content analysis qualitative methods. Professionals concurred with the concept that humanized birth is a changing and promising process, and can often bring normality to the midst of a high obstetric risk situation. No practice guidelines can be theoretically defined for humanized birth in a high risk pregnancy, as there is no conflict between humanized birth and medical intervention in such a situation. Barriers encountered in providing humanized birth in a high risk pregnancy include factors such as: the pressure of being responsible for the safety of the mother and the fetus, lack of the women's active involvement in the decision making process and the heavy burden of responsibility on the physician's shoulders, potential legal issues, and finally, the lack of midwifery authority in providing care at high risk pregnancy. The factors that facilitate humanized birth in a high risk include: the sharing of decision making and other various responsibilities between the physicians and the women; being caring; stress management, and the fact that the evolution of a better relationship and communication between the health professional and the patient will lead to a stress-free environment for both. Humanized birth in a high risk pregnancy is something that goes beyond just curing women of their illnesses. It can be considered as a token of caring, and continued support, which positively consolidates the doctor-patient relationship. As yet, it has not been described as a practiced guideline, due to its ever-changing complexities.
生育医学模式假定，怀孕总是有可能演变成高风险程序。为了在高危妊娠中倡导人性化分娩，重要的一步是启发专业人员对这种情况下人性化分娩的先入之见。本文的目的是确定专业人员对高危妊娠中实施人性化护理的潜在障碍和促进因素的看法。2008年6月至8月，来自临床和学术领域的21名助产士、产科医生和卫生管理人员在日本的9个不同地点接受了访谈。访谈进行了录音，并在参与者同意的情况下进行了转录。随后使用内容分析定性方法对数据进行了分析。专业人员认同人性化分娩是一个不断变化且充满希望的过程，并且通常可以在产科高风险情况下带来正常状态的观念。由于在这种情况下人性化分娩与医疗干预之间不存在冲突，因此从理论上无法为高危妊娠中的人性化分娩定义实践指南。在高危妊娠中提供人性化分娩时遇到的障碍包括：对母婴安全负责的压力、女性在决策过程中缺乏积极参与以及医生肩上的沉重责任负担、潜在的法律问题，最后是助产士在高危妊娠护理中缺乏权威。促进高危妊娠中人性化分娩的因素包括：医生与女性之间分担决策和其他各种责任；关怀；压力管理，以及卫生专业人员与患者之间更好的关系和沟通的发展将为双方带来无压力环境这一事实。高危妊娠中的人性化分娩不仅仅是治愈女性的疾病。它可以被视为关怀和持续支持的象征，这积极巩固了医患关系。由于其不断变化的复杂性，迄今为止，它尚未被描述为实践指南。
