National Perinatal Epidemiology Unit, Department of Public Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom.
BMC Pregnancy Childbirth. 2012 Nov 15;12:129. doi: 10.1186/1471-2393-12-129.
Midwifery units offer care to women with straightforward pregnancies, but unforeseen complications can arise during labour or soon after birth, necessitating transfer to a hospital obstetric unit. In England, 21% of women planning birth in freestanding midwifery units are transferred; in alongside units, the transfer rate is 26%. There is little high quality contemporary evidence on women's experience of transfer.
We carried out a qualitative interview study, using semi-structured interviews, with women who had been transferred from a midwifery unit (freestanding or alongside) in England up to 12 months prior to interview. Maximum variation sampling was used. Interviews with 30 women took place between March 2009 and March 2010. Thematic analysis using constant comparison and exploration of deviant cases was carried out.
Most women hoped for or expected a natural birth and did not expect to be transferred. Transfer was disappointing for many; sensitive and supportive care and preparation for the need for transfer helped women adjust to their changing circumstances. A small number of women, often in the context of prolonged labour, described transfer as a relief. For women transferred from freestanding units, the ambulance journey was a "limbo" period. Women wondered, worried or were fearful about what was to come and could be passive participants who felt like they were being "transported" rather than cared for. For many this was a direct contrast with the care they experienced in the midwifery unit. After transfer, most women appreciated the opportunity to talk about their experience to make sense of what happened and help them plan for future pregnancies, but did not necessarily seek this out if it was not offered.
Transfer affects a significant minority of women planning birth in midwifery units and is therefore a concern for women and midwives. Transfer is not expected by women, but sensitive care and preparation can help women adjust to changing circumstances. Particular sensitivity around decision-making may be required by midwives caring for women during prolonged labour. Some apparently straightforward changes to practice have the potential to make an important difference to women's experience of ambulance transfer.
助产士单位为妊娠正常的女性提供护理，但在分娩过程中或分娩后不久可能会出现意外并发症，需要转至医院产科病房。在英格兰，21%计划在独立助产士单位分娩的女性需要转院；在联合单位，转院率为 26%。关于女性转院体验的高质量当代证据很少。
我们对 2009 年 3 月至 2010 年 3 月期间接受采访前 12 个月内从英格兰的助产士单位（独立或联合）转院的女性进行了定性访谈研究，采用了半结构化访谈，使用最大变异抽样。共对 30 名女性进行了访谈。使用恒定比较和探索偏差案例进行了主题分析。
大多数女性希望或期望自然分娩，不希望转院。许多女性对转院感到失望；敏感和支持性的护理以及对转院需求的准备帮助女性适应了不断变化的环境。少数女性，通常在分娩时间延长的情况下，将转院描述为一种解脱。对于从独立单位转院的女性来说，乘坐救护车的过程是一段“中间地带”。女性会对即将发生的事情感到疑惑、担心或恐惧，并且可能是被动的参与者，感觉自己像是被“运送”而不是被照顾。对许多人来说，这与她们在助产士单位所经历的护理形成了鲜明对比。转院后，大多数女性都很感激有机会谈论自己的经历，以理解发生的事情并帮助她们为未来的怀孕做计划，但如果没有主动提出，她们并不一定需要这样做。
转院影响了计划在助产士单位分娩的少数女性，因此这是女性和助产士关注的问题。女性不希望转院，但敏感的护理和准备可以帮助她们适应不断变化的环境。在长时间分娩期间，助产士可能需要特别注意决策问题。一些看似简单的实践改变有可能对女性的救护车转院体验产生重要影响。
