Ampt Amanda J, de Vroome Michelle, Ford Jane B
Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia.
North Shore Ryde Health Service, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2015 Jun;55(3):251-6. doi: 10.1111/ajo.12330. Epub 2015 Jun 5.
Midwives are reported to have changed from 'hands on' to 'hands poised or off' approaches to birth at the same time as obstetric anal sphincter injuries (OASIs) are increasing. As perineal management details are not routinely collected, it is difficult to quantify practice.
To determine which perineal protections techniques midwives prefer for low-risk non-water births; whether preference is associated with technique taught or with other characteristics; and whether midwives change preference according to clinical scenario.
Midwives in Northern Sydney Local Health District (NSLHD) were surveyed during a 2-week period in 2014. Multiple-choice questions were used, with free text option. Descriptive analyses, chi-square and McNemar tests were undertaken.
One hundred and eight midwives participated (response rate 76.7%). 'Hands poised or off' was preferred by 63.0% for a low-risk birth. Current practice was associated with technique taught (P < 0.01). For scenarios with increased OASI risk midwives reported switching to 'hands on', with 83.4% employing 'hands on' whether there was concern about an impending OASI. There has been a shift over time from teaching 'hands on' to 'hands poised or off'.
The preferred technique for a low-risk birth appears to have changed from 'hands on' to 'hands poised or off', but most midwives adopt 'hands on' in situations of high risk for OASI. Further research is needed to establish whether there is an association with the rising OASI rate and the change in preferred perineal management technique for a low-risk birth.
据报道，在产科肛门括约肌损伤（OASIs）发生率上升的同时，助产士的接生方式已从“动手”转变为“手准备好或不接触”。由于会阴管理细节并非常规收集，因此难以量化实际操作情况。
确定助产士在低风险非水中分娩时更喜欢哪种会阴保护技术；偏好是否与所教授的技术或其他特征相关；以及助产士是否会根据临床情况改变偏好。
2014年，对北悉尼地方卫生区（NSLHD）的助产士进行了为期两周的调查。采用多项选择题，并提供自由文本选项。进行了描述性分析、卡方检验和麦克尼马尔检验。
108名助产士参与调查（回复率76.7%）。63.0%的助产士在低风险分娩时更喜欢“手准备好或不接触”的方式。当前的操作与所教授的技术相关（P < 0.01）。对于OASIs风险增加的情况，助产士报告称会改用“动手”方式，无论是否担心即将发生OASI，83.4%的助产士都会采用“动手”方式。随着时间的推移，教学方式已从“动手”转变为“手准备好或不接触”。
低风险分娩的首选技术似乎已从“动手”转变为“手准备好或不接触”，但大多数助产士在OASI高风险情况下会采用“动手”方式。需要进一步研究以确定OASIs发生率上升与低风险分娩时首选会阴管理技术的变化之间是否存在关联。
