Geerts Caroline C, Klomp Trudy, Lagro-Janssen Antoine L M, Twisk Jos W R, van Dillen Jeroen, de Jonge Ank
Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, the Netherlands.
BMC Pregnancy Childbirth. 2014 Jan 17;14:27. doi: 10.1186/1471-2393-14-27.
In the Netherlands, low risk women receive midwife-led care and can choose to give birth at home or in hospital. There is concern that transfer of care during labour from midwife-led care to an obstetrician-led unit leads to negative birth experiences, in particular among those with planned home birth. In this study we compared sense of control, which is a major attribute of the childbirth experience, for women planning home compared to women planning hospital birth under midwife-led care. In particular, we studied sense of control among women who were transferred to obstetric-led care during labour according to planned place of birth: home versus hospital.
We used data from the prospective multicentre DELIVER (Data EersteLIjns VERloskunde) cohort-study, conducted in 2009 and 2010 in the Netherlands. Sense of control during labour was assessed 6 weeks after birth, using the short version of the Labour Agentry Scale (LAS-11). A higher LAS-11 score indicates a higher feeling of control. We considered a difference of a minimum of 5.5 points as clinically relevant.
Nulliparous- and parous women who planned a home birth had a 2.6 (95% CI 1.0, 4.3) and a 3.0 (1.6, 4.4) higher LAS score during first stage of labour respectively and during second stage a higher score of 2.8 (0.9, 4.7) and 2.3 (0.6, 4.0), compared with women who planned a hospital birth. Overall, women who were transferred experienced a lower sense of control than women who were not transferred. Parous women who planned a home birth and who were transferred had a 4.3 (0.2, 8.4) higher LAS score in 2nd stage, compared to those who planned a hospital birth and who were transferred.
We found no clinically relevant differences in feelings of control among women who planned a home or hospital birth. Transfer of care during labour lowered feelings of control, but feelings of control were similar for transferred women who planned a home or hospital birth.As far as their expected sense of control is concerned, low risk women should be encouraged to give birth at the location of their preference.
在荷兰，低风险女性接受由助产士主导的护理，并可选择在家中或医院分娩。有人担心，分娩过程中护理从助产士主导转为产科医生主导会导致负面的分娩体验，尤其是那些计划在家分娩的女性。在本研究中，我们比较了计划在家分娩的女性与计划在医院由助产士主导护理下分娩的女性的控制感，控制感是分娩体验的一个主要属性。特别是，我们研究了根据计划分娩地点（家中与医院）在分娩期间转至产科主导护理的女性的控制感。
我们使用了2009年和2010年在荷兰进行的前瞻性多中心DELIVER（初产护理数据）队列研究的数据。分娩后6周使用分娩自主性量表简版（LAS - 11）评估分娩期间的控制感。LAS - 11得分越高表明控制感越强。我们将至少5.5分的差异视为具有临床相关性。
与计划在医院分娩的女性相比，计划在家分娩的初产妇和经产妇在第一产程中的LAS得分分别高2.6（95%CI 1.0，4.3）和3.0（1.6，4.4），在第二产程中的得分分别高2.8（0.9，4.7）和2.3（0.6，4.0）。总体而言，转至产科主导护理的女性的控制感低于未转至产科主导护理的女性。与计划在医院分娩且转至产科主导护理的经产妇相比，计划在家分娩且转至产科主导护理的经产妇在第二产程中的LAS得分高4.3（0.2，8.4）。
我们发现计划在家分娩或在医院分娩的女性在控制感方面没有临床相关差异。分娩期间护理的转移降低了控制感，但计划在家分娩或在医院分娩的转至产科主导护理的女性的控制感相似。就她们预期的控制感而言，应鼓励低风险女性在其偏好的地点分娩。
