连续护理是否会影响剖宫产术后下次分娩（VBAC）的决策？一项随机对照试验。
Does continuity of care impact decision making in the next birth after a caesarean section (VBAC)? a randomised controlled trial.
机构信息
Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Level 7, 235-253 Jones St, Broadway, Sydney, NSW, Australia.
出版信息
BMC Pregnancy Childbirth. 2013 Jul 2;13:140. doi: 10.1186/1471-2393-13-140.
BACKGROUND
Caesarean section (CS) has short and long-term health effects for both the woman and her baby. One of the greatest contributors to the CS rate is elective repeat CS. Vaginal birth after caesarean (VBAC) is an option for many women; despite this the proportion of women attempting VBAC remains low. Potentially the relationship that women have with their healthcare professional may have a major influence on the uptake of VBAC. Models of service delivery, which enable an individual approach to care, may make a difference to the uptake of VBAC. Midwifery continuity of care could be an effective model to encourage and support women to choose VBAC.
METHODS/DESIGN: A randomised, controlled trial will be undertaken. Eligible pregnant women, whose most recent previous birth was by lower-segment CS, will be randomly allocated 1:1 to an intervention group or control group. The intervention provides midwifery continuity of care to women through pregnancy, labour, birth and early postnatal care. The control group will receive standard hospital care from different midwives through pregnancy, labour, birth and early postnatal care. Both groups will receive an obstetric consultation during pregnancy and at any other time if required. Clinical care will follow the same guidelines in both groups.
DISCUSSION
This study will determine whether midwifery continuity of care influences the decision to attempt a VBAC and impacts on mode of birth, maternal experiences with care and the health of the neonate. Outcomes from this study might influence the way maternity care is provided to this group of women and thus impact on the CS rate. This information will provide high level evidence to policy makers, health service managers and practitioners who are working towards addressing the increased rate of CS.
TRIAL REGISTRATION
This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611001214921.
背景
剖宫产术（CS）对母婴的健康都有短期和长期的影响。导致 CS 率升高的原因之一是选择性重复 CS。对于许多女性来说，剖宫产后阴道分娩（VBAC）是一种选择；尽管如此，尝试 VBAC 的女性比例仍然很低。女性与医疗保健专业人员的关系可能对 VBAC 的采用有重大影响。能够实现个性化护理的服务提供模式可能会对 VBAC 的采用产生影响。助产士连续护理可能是一种鼓励和支持女性选择 VBAC 的有效模式。
方法/设计：将进行一项随机对照试验。最近一次剖宫产术为下段剖宫产术的孕妇将被随机分配 1:1 到干预组或对照组。干预措施通过妊娠、分娩和产后早期护理为女性提供助产士连续护理。对照组将在妊娠、分娩、产后和产后早期护理期间接受不同助产士的标准医院护理。两组均将在妊娠期间和需要时接受产科咨询。两组的临床护理将遵循相同的指南。
讨论
本研究将确定助产士连续护理是否会影响尝试 VBAC 的决定，并影响分娩方式、产妇对护理的体验以及新生儿的健康。这项研究的结果可能会影响为这群女性提供的产科护理方式，从而影响 CS 率。该信息将为政策制定者、卫生服务管理人员和从业者提供高水平的证据，他们正在努力解决 CS 率上升的问题。
试验注册
该试验在澳大利亚新西兰临床试验注册中心（ANZCTR）注册：ACTRN12611001214921。
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