正常分娩中阴道检查实践的悖论：巴勒斯坦妇女的感受、意见、知识和经验。
The paradox of vaginal examination practice during normal childbirth: Palestinian women's feelings, opinions, knowledge and experiences.
机构信息
Section of Preventive Medicine and Epidemiology, Department of Community Medicine, Institute of Health and Society, Faculty of Medicine, University of Oslo, Box 1130, 0318 Oslo, Norway.
出版信息
Reprod Health. 2012 Aug 28;9:16. doi: 10.1186/1742-4755-9-16.
BACKGROUND
Vaginal examination (VE), is a frequent procedure during childbirth. It is the most accepted ways to assess progress during childbirth, but its repetition at short intervals has no value. Over years, VE continued to be plagued by a nature that implies negative feelings and experiences of women. The aim of this exploratory qualitative study was to explore women's feelings, opinions, knowledge and experiences of vaginal examinations (VE) during normal childbirth.
METHODS
We interviewed 176 postpartum women using semi-structured questionnaire in a Palestinian public hospital in the oPt. Descriptive statistics were conducted; frequency counts and percentages for the quantitative questions. The association between the frequency of VE and age, parity, years of education, locale and the time of delivery was tested by Chi-squared and Fisher's Exact test. The open-ended qualitative questions were read line-by-line for the content and coded. The assigned codes for all responses were entered to the SPSS statistical software version 18.
RESULTS
As compared with WHO recommendations, VE was conducted too frequently, and by too many providers during childbirth. The proportion of women who received a 'too high' frequency of VEs during childbirth was significantly larger in primipara as compared to multipara women (P = .037). 82% of women reported pain or severe pain and 68% reported discomfort during VE. Some women reported insensitive approaches of providers, insufficient means of privacy and no respect of dignity or humanity during the exam.
CONCLUSIONS
Palestinian women are undergoing unnecessary and frequent VEs during childbirth, conducted by several different providers and suffer pain and discomfort un-necessarily.
PRACTICE IMPLICATIONS
Adhering to best evidence, VE during childbirth should be conducted only when necessary, and if possible, by the same provider. This will decrease the laboring women's unnecessary suffering from pain and discomfort. Providers should advocate for women's right to information, respect, dignity and privacy.
背景
阴道检查（VE）是分娩过程中的常见程序。它是评估分娩进展最常用的方法，但频繁地短时间内重复进行并无价值。多年来，VE 一直受到一种暗示女性负面感受和体验的性质的困扰。本探索性定性研究旨在探讨女性在正常分娩过程中对阴道检查（VE）的感受、意见、知识和经验。
方法
我们在巴勒斯坦 oPt 的一家公立医院使用半结构式问卷对 176 名产后妇女进行了采访。进行了描述性统计；对定量问题进行了频率计数和百分比。通过卡方检验和 Fisher 精确检验检验 VE 的频率与年龄、产次、受教育年限、地点和分娩时间之间的关联。对所有回复的开放式定性问题进行逐行阅读以获取内容并进行编码。为所有回复分配的代码都输入到 SPSS 统计软件版本 18 中。
结果
与世卫组织的建议相比，VE 在分娩过程中进行得过于频繁，而且由太多的提供者进行。与经产妇相比，初产妇在分娩期间接受“过高”频率 VE 的比例明显更大（P=0.037）。82%的女性报告在 VE 过程中有疼痛或剧烈疼痛，68%的女性报告在 VE 过程中有不适。一些女性报告提供者的方法不敏感，隐私手段不足，检查过程中没有尊重尊严或人性。
结论
巴勒斯坦妇女在分娩过程中接受了不必要的频繁 VE，由多位不同的提供者进行，并且不必要地遭受疼痛和不适。
实践意义
遵循最佳证据，分娩时应仅在必要时进行 VE，如果可能的话，由同一提供者进行。这将减少产妇因疼痛和不适而遭受的不必要痛苦。提供者应倡导妇女享有知情权、尊重、尊严和隐私的权利。
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