Kennedy Holly Powell, Cheyney Melissa, Lawlor Mary, Myers Suzy, Schuiling Kerri, Tanner Tanya
J Midwifery Womens Health. 2015 Mar-Apr;60(2):140-5. doi: 10.1111/jmwh.12254.
This article describes the process of developing consensus on a definition of, and best practices for, normal physiologic birth in the United States. Evidence supports the use of physiologic birth practices, yet a working definition of this term has been elusive.
We began by convening a task force of 21 individuals from 3 midwifery organizations and various childbirth advocacy and consumer groups. A modified Delphi approach was utilized to achieve consensus around 2 research questions: 1) What is normal physiologic birth? and 2) What practices most effectively support its achievement? Answers to these questions were collected anonymously from task force members during multiple phases that included a preliminary briefing, an initial face-to-face roundtable, 9 iterative Delphi rounds, and reciprocal feedback from a wider audience of stakeholders at national and international conferences. Content analysis identified specific statements and concepts in the first Delphi round, which were subsequently ranked in following rounds. An initial draft was constructed based on the priorities that emerged and presented for feedback to peers and childbirth advocates whose comments were incorporated into the final document.
Four key themes were identified from our initial questions; these provided the framework for the document: 1) definitions of normal physiologic birth, 2) mechanisms and outcomes of normal physiologic birth, 3) factors that influence normal physiologic birth, and 4) recommendations for increasing normal physiologic birth. These areas comprised the final sections in the multi-organizational consensus statement.
The modified Delphi approach we employed allowed for the development of a consensus statement that will serve as a template for education, practice, and future research in maternity care. The completion of this statement marks the beginning of a project to promote systemic changes that support normal physiologic birth, and thus, have the potential to improve outcomes for mothers and infants.
本文描述了在美国就正常生理分娩的定义和最佳实践达成共识的过程。有证据支持采用生理分娩实践，但该术语的有效定义一直难以捉摸。
我们首先召集了一个由来自3个助产组织以及各种分娩倡导和消费者团体的21人组成的特别工作组。采用改良的德尔菲法围绕2个研究问题达成共识：1）什么是正常生理分娩？2）哪些实践最有效地支持其实现？在多个阶段中，从特别工作组成员那里匿名收集这些问题的答案，这些阶段包括初步简报、首次面对面圆桌会议、9轮迭代德尔菲法以及在国内和国际会议上从更广泛的利益相关者群体获得的相互反馈。内容分析在第一轮德尔菲法中确定了具体陈述和概念，随后在后续轮次中进行排名。根据出现的优先事项构建了初稿，并提交给同行和分娩倡导者征求反馈，他们的意见被纳入了最终文件。
从我们最初的问题中确定了四个关键主题；这些主题为文件提供了框架：1）正常生理分娩的定义，2）正常生理分娩的机制和结果，3）影响正常生理分娩的因素，4）增加正常生理分娩的建议。这些领域构成了多组织共识声明的最后部分。
我们采用的改良德尔菲法促成了一份共识声明的制定，该声明将作为产科护理教育、实践和未来研究的模板。这份声明的完成标志着一个促进系统性变革的项目的开始，这些变革支持正常生理分娩，因此有可能改善母婴结局。
