Nicholls Sarah, Hauck Yvonne L, Bayes Sarah, Butt Janice
School of Nursing and Midwifery, Curtin University, GPO Box U1987, Perth, Western Australia, Australia.
School of Nursing and Midwifery, Curtin University, GPO Box U1987, Perth, Western Australia, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, PO Box 134, Subiaco 6904, Western Australia, Australia.
Midwifery. 2016 Feb;33:73-81. doi: 10.1016/j.midw.2015.10.010. Epub 2015 Oct 25.
the option of labouring and/or birthing immersed in warm water has become widely available throughout hospitals in the United Kingdom and Europe over the last two decades. The practice, which also occurs in New Zealand and interstate in Australia, has until recently only been available in Western Australia for women birthing at home with a small publically funded Community Midwifery Program. Despite its popularity and acceptance elsewhere, birth in water has only recently become an option for women attending some public health services in Western Australia. The Clinical Guidelines developed for the local context that support water birth require that the midwives be confident and competent to care for these women. The issue of competency can be addressed with relative ease by maternity care providers; however confidence is rather more difficult to teach, foster and attain. Clinical confidence is an integral element of clinical judgement and promotes patient safety and comfort. For this reason confident midwives are an essential requirement to support the option of water birth in Western Australia. The aim of this study was to capture midwives' perceptions of becoming and being confident in conducting water birth in addition to factors perceived to inhibit and facilitate the development of that confidence.
a modified grounded theory methodology with thematic analysis.
four public maternity services offering the option of water birth in the Perth metropolitan area.
registered midwives employed at one of the four publicly funded maternity services that offered the option of water birth between June 2011 and June 2013. Sixteen midwives were interviewed on a one to one basis. An additional 10 midwives participated in a focus group interview.
three main categories emerged from the data analysis: what came before the journey, becoming confident - the journey and staying confident. Each contained between three and five subcategories. Together they depicted how midwives describe the journey to becoming confident to support women who have chosen the option to water birth and how they are able to retain that confidence once achieved.
three key implications emerged from this study, the first was that students and graduate midwives could benefit from the opportunity to work in midwifery led maternity settings that support normal physiological child birth and that accessing such practical placements should be encouraged. Secondly, maternity services would benefit from learning opportunities directed specifically at experienced midwives addressing their particular requirements. Finally, midwives are the custodians of normal physiological birth, attendance at educational days with a focus on supporting this primary role should be mandatory, to inform midwives on current evidence found to support normal birth which includes options such as water birth.
在过去二十年里，在温水中分娩和/或生产的选择在英国和欧洲的医院中已广泛普及。这种做法在新西兰和澳大利亚的州际地区也有出现，直到最近，在西澳大利亚州，只有通过一个小规模的公共资助社区助产项目在家分娩的女性才有此选择。尽管水中分娩在其他地方很受欢迎且被广泛接受，但在西澳大利亚州，只是最近才成为一些公共卫生服务机构中女性的一种分娩选择。为当地情况制定的支持水中分娩的临床指南要求助产士有信心且有能力护理这些女性。护理提供者相对容易解决能力问题；然而，信心却更难传授、培养和获得。临床信心是临床判断的一个组成部分，能促进患者的安全和舒适。因此，自信的助产士是支持西澳大利亚州水中分娩选择的一项基本要求。本研究的目的是了解助产士对于在进行水中分娩时变得自信及保持自信的看法，以及那些被认为会抑制和促进这种信心发展的因素。
采用带有主题分析的改良扎根理论方法。
珀斯都会区提供水中分娩选择的四个公共产科服务机构。
在2011年6月至2013年6月期间，受雇于四个提供水中分娩选择的公共资助产科服务机构之一的注册助产士。16名助产士接受了一对一访谈。另外10名助产士参加了焦点小组访谈。
数据分析得出三个主要类别：旅程之前的情况、变得自信——旅程以及保持自信。每个类别包含三到五个子类别。它们共同描述了助产士如何讲述自己变得有信心去支持选择水中分娩的女性的过程，以及她们一旦获得信心后如何保持这种信心。
本研究产生了三个关键启示，第一，学生助产士和毕业初期助产士可能会从在以助产为主导的产科环境中工作的机会中受益，这种环境支持正常生理分娩，应鼓励获得此类实践实习机会。第二，产科服务机构将从专门针对有经验的助产士、满足其特定需求的学习机会中受益。最后，助产士是正常生理分娩的守护者，应强制要求她们参加以支持这一主要角色为重点的教育日活动，以便让助产士了解目前发现的支持正常分娩的证据，其中包括水中分娩等选择。
