School of Nursing and Midwifery, Faculty of Health Sciences, Australian Catholic University, St Patrick's Campus, Victoria Parade, Fitzroy 3065, Victoria, Australia.
Midwifery. 2010 Oct;26(5):526-31. doi: 10.1016/j.midw.2010.06.011. Epub 2010 Aug 9.
to explore and describe midwives perceptions of birth space and clinical risk management and their impact on practice both before and after a move to a new facility.
an exploratory descriptive study utilising a modified participatory approach and observation and focus groups for data collection.
a major metropolitan maternity hospital in Victoria, Australia.
18 midwives, including graduate year midwives, caseload midwives and hospital midwives working normal shifts, employed within a hospital.
the major themes identified were perceptions of birth space, perceptions of risk management, influence of birth space and risk management on practice and moving but not changing: geographical space and practice. Midwives desire to create the ideal birth space was hampered by a prevailing biomedical discourse which emphasised risk. Midwives in all three groups saw themselves as the gatekeepers, 'holding the space' or 'providing a bridge' for women, often in the face of a hierarchical hospital structure with obstetricians governing practice. This situation did not differ significantly after the relocation to the new hospital. Despite a warmer, more spacious and private birth space midwives felt the care was still influenced by the old hierarchical hospital culture. Caseload midwives felt they had the best opportunity to make a difference to women's experience because they were able, through continuity of care, to build trusting relationships with women during the antenatal period.
although the physical environment can make a marginal contribution to an optimal birth space, it has little effect on clinical risk management practices within a major public hospital and the way in which this impacts midwives' practice. The importance of place and people are the key to providing an optimal birth space, as are women centred midwifery models of care and reasonable workloads.
探讨和描述助产士对分娩环境和临床风险管理的看法，以及它们在搬入新设施前后对实践的影响。
利用改良的参与式方法和观察及焦点小组收集数据的探索性描述研究。
澳大利亚维多利亚州一家主要的大都市妇产医院。
18 名助产士，包括研究生年助产士、病例助产士和在医院正常轮班工作的医院助产士，均在医院工作。
确定的主要主题是对分娩环境的看法、对风险管理的看法、分娩环境和风险管理对实践的影响以及搬而未变：地理空间和实践。阻碍助产士创造理想分娩环境的主要因素是普遍存在的强调风险的生物医学话语。所有三组助产士都将自己视为守门员，“为女性守住空间”或“提供桥梁”，常常面对以产科医生主导实践的等级森严的医院结构。这种情况在搬迁到新医院后并没有明显改变。尽管有一个更温暖、更宽敞和更私人的分娩环境，助产士们觉得护理仍然受到旧的等级森严的医院文化的影响。病例助产士认为，他们有最好的机会为女性的体验带来改变，因为他们能够通过连续护理，在产前与女性建立信任关系。
尽管物理环境可以对最佳分娩环境做出微小贡献，但在大型公立医院中，它对临床风险管理实践几乎没有影响，以及这如何影响助产士的实践。地点和人员的重要性是提供最佳分娩环境的关键，以妇女为中心的助产士护理模式和合理的工作量也是如此。
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