Foureur Maralyn, Turkmani Sabera, Clack Danielle C, Davis Deborah L, Mollart Lyndall, Leiser Bernadette, Homer Caroline S E
Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia.
University of Canberra, Australian Capital Territory (ACT), Australia; The ACT Government, Health Directorate, Australia.
Women Birth. 2017 Feb;30(1):3-8. doi: 10.1016/j.wombi.2016.05.011. Epub 2016 Jun 16.
One of the greatest contributors to the overall caesarean section rate is elective repeat caesarean section.
Decisions around mode of birth are often complex for women and influenced by the views of the doctors and midwives who care for and counsel women. Women may be more likely to choose a repeat elective caesarean section (CS) if their health care providers lack skills and confidence in supporting vaginal birth after caesarean section (VBAC).
To explore the views and experiences of providers in caring for women considering VBAC, in particular the decision-making processes and the communication of risk and safety to women.
A descriptive interpretive method was utilised. Four focus groups with doctors and midwives were conducted.
The central themes were: 'developing trust', 'navigating the system' and 'optimising support'. The impact of past professional experiences; the critical importance of continuity of carer and positive relationships; the ability to weigh up risks versus benefits; and the language used were all important elements. The role of policy and guidelines on providing standardised care for women who had a previous CS was also highlighted.
Midwives and doctors in this study were positively oriented towards assisting and supporting women to attempt a VBAC. Care providers considered that women who have experienced a prior CS need access to midwifery continuity of care with a focus on support, information-sharing and effective communication.
总体剖宫产率的最大促成因素之一是选择性再次剖宫产。
对于女性而言，分娩方式的决策往往很复杂，并且会受到照顾和咨询女性的医生及助产士观点的影响。如果医疗服务提供者缺乏支持剖宫产术后阴道分娩（VBAC）的技能和信心，女性可能更倾向于选择再次选择性剖宫产。
探讨医疗服务提供者在照顾考虑VBAC的女性时的观点和经验，特别是决策过程以及向女性传达风险和安全性的情况。
采用描述性解释方法。对医生和助产士进行了四个焦点小组访谈。
核心主题为：“建立信任”“应对系统”和“优化支持”。过去的专业经验的影响；护理连续性和积极关系的至关重要性；权衡风险与益处的能力；以及所使用的语言都是重要因素。还强调了政策和指南在为曾有剖宫产史的女性提供标准化护理方面的作用。
本研究中的助产士和医生积极致力于协助和支持女性尝试VBAC。护理提供者认为，有过剖宫产史的女性需要获得以支持、信息共享和有效沟通为重点的助产士连续性护理。
