Wong Nola, Browne Jenny, Ferguson Sally, Taylor Jan, Davis Deborah
University of Canberra, Bruce, ACT, Australia; Centenary Hospital for Women and Children, ACT, Australia.
University of Canberra, Bruce, ACT, Australia.
Women Birth. 2015 Dec;28(4):279-84. doi: 10.1016/j.wombi.2015.06.005. Epub 2015 Jul 17.
There is national and international concern for increasing obstetric intervention in childbirth and rising caesarean section rates. Repeat caesarean section is a major contributing factor, making primiparous women an important target for strategies to reduce unnecessary intervention and surgeries in childbirth.
The aim was to compare outcomes for a cohort of low risk primiparous women who accessed a midwifery continuity model of care with those who received standard public care in the same tertiary hospital.
A retrospective comparative cohort study design was implemented drawing on data from two databases held by a tertiary hospital for the period 1 January 2010 to 31 December 2011. Categorical data were analysed using the chi-squared statistic and Fisher's exact test. Continuous data were analysed using Student's t-test. Comparisons are presented using unadjusted and adjusted odds ratios, with 95% confidence intervals (CIs) and p-values with significance set at 0.05.
Data for 426 women experiencing continuity of midwifery care and 1220 experiencing standard public care were compared. The study found increased rates of normal vaginal birth (57.7% vs. 48.9% p=0.002) and spontaneous vaginal birth (38% vs. 22.4% p=<0.001) and decreased rates of instrumental birth (23.5% vs. 28.5% p=0.050) and caesarean sections (18.8% vs. 22.5% p=0.115) in the midwifery continuity cohort. There were also fewer interventions in this group. No differences were found in neonatal outcomes.
Strategies for reducing caesarean section rates and interventions in childbirth should focus on primiparous women as a priority. This study demonstrates the effectiveness of continuity midwifery models, suggesting that this is an important strategy for improving outcomes in this population.
国内外都对分娩时产科干预的增加以及剖宫产率的上升表示关注。再次剖宫产是一个主要促成因素，这使得初产妇成为减少分娩中不必要干预和手术策略的重要目标人群。
本研究旨在比较一组采用助产士连续性照护模式的低风险初产妇与在同一家三级医院接受标准公共照护的初产妇的结局。
采用回顾性比较队列研究设计，利用一家三级医院在2010年1月1日至2011年12月31日期间所保存的两个数据库中的数据。分类数据采用卡方检验和Fisher精确检验进行分析。连续数据采用学生t检验进行分析。比较结果采用未调整和调整后的比值比表示，并给出95%置信区间（CI）以及p值，显著性水平设定为0.05。
对426名接受助产士连续性照护的产妇和1220名接受标准公共照护的产妇的数据进行了比较。研究发现，助产士连续性照护队列中的正常阴道分娩率（57.7%对48.9%，p = 0.002）和自然阴道分娩率（38%对22.4%，p < 0.001）有所提高，器械助产率（23.5%对28.5%，p = 0.050）和剖宫产率（18.8%对22.5%，p = 0.115）有所降低。该组的干预措施也较少。新生儿结局方面未发现差异。
降低剖宫产率和分娩干预措施的策略应优先关注初产妇。本研究证明了助产士连续性照护模式的有效性，表明这是改善该人群结局的一项重要策略。
