Vogt Sibylle Emilie, Silva Kátia Silveira da, Dias Marcos Augusto Bastos
Departamento de Enfermagem, Universidade Estadual de Montes Claros, Montes Claros, MG, Brasil.
Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Rev Saude Publica. 2014 Apr;48(2):304-13. doi: 10.1590/s0034-8910.2014048004633.
To compare collaborative and traditional childbirth care models.
Cross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used.
Paid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p < 0.001), amniotomy (54.3% collaborative model and 65.9% traditional model; p = 0.012) and episiotomy (collaborative model 16.1% and traditional model 85.2%; p < 0.001) were less used in the collaborative model with increased application of non-pharmacological pain relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia.
The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes.
比较协作式和传统式分娩护理模式。
2011年在巴西东南部米纳斯吉拉斯州贝洛奥里藏特市的四家公共卫生系统医院对655名初产妇进行横断面研究（协作式模式333名妇女，传统式模式322名妇女，包括引产或早产的妇女）。通过访谈和病历收集数据。采用卡方检验比较结果，并使用多因素逻辑回归确定该模式与所采用干预措施之间的关联。
有偿工作和受教育程度在两种模式之间的分布存在显著差异。协作式模式中缩宫素（50.2%）、人工破膜（54.3%）和会阴切开术（16.1%）的使用比例低于传统式模式（分别为65.5%、65.9%和85.2%）（p<0.001、p = 0.012、p<0.001），而非药物性镇痛的应用增加（协作式模式85.0%，传统式模式78.9%；p = 0.042）。在对混杂因素进行调整后，协作式模式与缩宫素、人工破膜和会阴切开术使用减少之间的关联仍然存在。护理模式与新生儿或母亲的并发症以及脊髓或硬膜外镇痛的使用均无关联。
结果表明，协作式模式可能会减少分娩护理中的干预措施，同时围产期结局相似。
