Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Broadway, NSW 2007, Australia.
Midwifery. 2013 Apr;29(4):300-7. doi: 10.1016/j.midw.2012.01.010. Epub 2012 Feb 17.
maternal and perinatal morbidity and mortality rates in Cambodia are high. The provision of quality care by skilled birth attendants (SBAs) in a supportive working environment is an important strategy to reduce morbidity and mortality. There has been little emphasis on examining this issue in Cambodia. The objective of this study was to establish SBA reported practices during labour, birth and the immediate postpartum periods and the factors affecting this.
a descriptive qualitative design was employed using in-depth interviews and focus group discussions with midwives, nurses and doctors with midwifery skills in two health centres and three referral hospitals in one province of Cambodia. Data were analysed using a thematic framework.
SBA practice is not always consistent with evidence-based standards known to reduce morbidity and mortality. Ten inter-related themes emerged, which described patterns of SBA practice, were identified. These were: skills in the care of labouring women; provision of support in labour; interventions in the second stage of labour; management of the third stage of labour; cleanliness during birth; immediate care of the newborn infant and immediate postnatal care; lack of policy and authority; fear of litigation; workload and lack of human resources; and financial incentives and socio-economic influences.
a gap exists between evidence-based standards and current SBA practice during labour, birth and the immediate postpartum care. This is largely driven by the lack of a supportive working environment.
the findings of this research provide maternal health services, workforce planners and policy makers with valuable information to contribute to the continuous quality improvement of maternity care. The findings highlight implications for practice that may improve the quality of maternal health care. Recommendations for decision makers were made and further research is needed in order to develop theories and recommendations to improve SBA practice in Cambodia, to the benefit of the Cambodia women and newborn babies.
柬埔寨的母婴发病率和死亡率较高。在支持性工作环境中，由熟练的接生员（SBA）提供优质护理是降低发病率和死亡率的重要策略。然而，在柬埔寨，人们很少强调研究这个问题。本研究的目的是确定 SBA 在分娩、分娩和产后即刻期间的报告实践以及影响这些实践的因素。
采用描述性定性设计，在柬埔寨一个省的两个卫生中心和三家转诊医院，对具有助产技能的助产士、护士和医生进行深入访谈和焦点小组讨论。使用主题框架分析数据。
SBA 的实践并不总是符合已知可降低发病率和死亡率的循证标准。出现了 10 个相互关联的主题，描述了 SBA 实践模式，这些主题包括：对分娩妇女护理的技能；在分娩过程中提供支持；第二产程的干预措施；第三产程的管理；分娩时的清洁；新生儿的即时护理和产后即时护理；缺乏政策和权威；对诉讼的恐惧；工作量和人力资源短缺；以及经济激励和社会经济影响。
在分娩、分娩和产后即刻护理期间，基于证据的标准与当前 SBA 实践之间存在差距。这主要是由于缺乏支持性工作环境造成的。
这项研究的结果为产妇保健服务、劳动力规划者和决策者提供了有价值的信息，有助于不断提高产妇保健质量。调查结果强调了对实践的影响，这可能会提高产妇保健的质量。为决策者提出了建议，并需要进一步研究，以制定理论和建议，以改善柬埔寨的 SBA 实践，造福柬埔寨妇女和新生儿。
