Chinkam Somphit, Ewan Jean, Koeniger-Donohue Rebecca, Hawkins Joellen W, Shorten Allison
J Midwifery Womens Health. 2016 Sep;61(5):613-620. doi: 10.1111/jmwh.12466. Epub 2016 Jul 18.
The purpose of this study was to evaluate how a scripted counseling intervention affected the experience of decision making and actual choice for trial of labor after cesarean (TOLAC) or elective repeat cesarean birth (ERCB) in a cohort of women receiving care from nurse-midwives.
A pilot study of scripted counseling for women who had a previous cesarean about TOLAC versus ERCB was conducted at Boston Medical Center. Candidates for a TOLAC, receiving prenatal care from nurse-midwives in 2012 and 2013, were enrolled before 28 weeks' gestation. The women received 4 scripted counseling sessions during the routine prenatal visit, evidence-based information pamphlets, and an opportunity to review the hospital TOLAC consent form. Pre and post questionnaires were completed regarding birth preference, information sources, and decision factors. A midpoint assessment of the participants' knowledge of risks and benefits of TOLAC versus ERCB was conducted, and satisfaction with the intervention and outcome were assessed after the birth.
Twenty-two women participated in the study, and 20 completed all study questionnaires. More of the participants believed they had enough information after the intervention (95% after intervention vs 70% before the intervention). Reasons for choosing ERCB included being afraid of vaginal birth complications, having prior positive experience with cesarean, and convenience of knowing when the neonate will be born. Reasons for choosing a TOLAC included the personal importance of having a vaginal birth and that recovery is faster and easier. Few women cited concerns for their own safety and that of their newborns when choosing TOLAC.
Women were satisfied with the scripted counseling and found it useful in helping them make a birth mode decision. While the scripted counseling did not appear to influence preferred mode of birth, it appeared to help women follow through with the mode of birth they chose prenatally.
本研究的目的是评估一种脚本式咨询干预措施如何影响一组接受助产士护理的女性在剖宫产术后试产（TOLAC）或择期再次剖宫产（ERCB）时的决策体验和实际选择。
在波士顿医疗中心对有剖宫产史的女性进行了一项关于TOLAC与ERCB的脚本式咨询试点研究。2012年和2013年接受助产士产前护理的TOLAC候选人在妊娠28周前入组。这些女性在常规产前检查期间接受了4次脚本式咨询、基于证据的信息手册，并获得了审查医院TOLAC同意书的机会。完成了关于分娩偏好、信息来源和决策因素的前后调查问卷。对参与者关于TOLAC与ERCB的风险和益处的知识进行了中期评估，并在分娩后评估了对干预措施和结果的满意度。
22名女性参与了研究，20名完成了所有研究问卷。更多参与者认为干预后她们获得了足够的信息（干预后为95%，干预前为70%）。选择ERCB的原因包括害怕阴道分娩并发症、既往有剖宫产的良好体验以及知道新生儿何时出生的便利性。选择TOLAC的原因包括阴道分娩的个人重要性以及恢复更快更容易。很少有女性在选择TOLAC时提及对自身及新生儿安全的担忧。
女性对脚本式咨询感到满意，并发现它有助于她们做出分娩方式的决定。虽然脚本式咨询似乎没有影响首选的分娩方式，但它似乎有助于女性坚持她们产前选择的分娩方式。
