Sahlin Maria, Andolf Ellika, Edman Gunnar, Wiklund Ingela
Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
Sex Reprod Healthc. 2017 Mar;11:112-116. doi: 10.1016/j.srhc.2016.04.002. Epub 2016 Apr 28.
A knowledge gap exists around midwives' and obstetricians' mode of delivery in comparison to the general population, and if their personal experience influences their attitudes towards different modes of delivery.
The aim of the present study was to investigate midwives' and obstetricians' mode of delivery compared to the population at large. The second aim was to see if their mode of delivery had been influenced by the expanded indications for caesarean section as described in medical literature. Thirdly, the differences between obstetricians' and midwifes' attitudes to caesarean section on maternal request was investigated.
Textbooks from midwifery education and medical schools were reviewed using a structured protocol. A questionnaire for midwives and obstetricians containing questions on mode of delivery, attitudes towards patients' autonomy and performing caesarean sections on maternal request was sent to 380 midwives and 97 obstetricians born in 1935, 1955 or 1975 with an invitation to participate in the study. Two hundred and sixty three midwives and 55 obstetricians provided completed responses.
The review of textbooks identified that the number of indications for caesarean section has increased. Indications for caesarean section increased in medical textbooks from seven in the oldest books, from year 1955, to 11 in the textbook from 1993. The focus has shifted in more recently published textbooks to prevention of fatal deliveries. In earlier obstetric care they tend to learn to solve the catastrophe when it had occurred. No significant relationship between midwives' and obstetricians; own mode of delivery and their attitudes towards performing a caesarean section on maternal request (p = 0.191) was found. Thirty percent of the obstetricians reported that they would perform a caesarean section if the pregnant woman requested one. The study found a significant difference between the professions in the statement "the proportion of caesarean section is too high" where midwives to a greater extent agreed with the statement (p = 0.033). There were no significant differences between caesarean section as the mode of delivery for midwives and obstetricians as compared to the general population. Midwives born in 1975 had significantly lower rate of instrumental births compared to the population at large (p < 0.05).
Over the years, the indications for caesarean section have increased. The increase is shown in both the textbooks read during the different time periods as well as among the Swedish midwives and obstetricians born in 1955 and 1975.
与普通人群相比，助产士和产科医生的分娩方式存在知识空白，以及他们的个人经历是否会影响他们对不同分娩方式的态度。
本研究的目的是调查助产士和产科医生与广大人群相比的分娩方式。第二个目的是查看他们的分娩方式是否受到医学文献中所述剖宫产指征扩大的影响。第三，调查产科医生和助产士对产妇要求剖宫产的态度差异。
使用结构化方案对助产士教育和医学院校的教科书进行了审查。向380名助产士和97名分别出生于1935年、1955年或1975年的产科医生发送了一份问卷，其中包含有关分娩方式、对患者自主权的态度以及应产妇要求进行剖宫产的问题，并邀请他们参与研究。263名助产士和55名产科医生提供了完整的回复。
对教科书的审查发现剖宫产指征的数量有所增加。剖宫产指征在医学教科书中从1955年最旧书籍中的7条增加到1993年教科书中的11条。在最近出版的教科书中，重点已转向预防致命分娩。在早期的产科护理中，他们倾向于在灾难发生后学会解决问题。未发现助产士和产科医生自己的分娩方式与他们对应产妇要求进行剖宫产的态度之间存在显著关系（p = 0.191）。30%的产科医生报告说，如果孕妇要求，他们会进行剖宫产。研究发现，在“剖宫产比例过高”这一表述上，不同职业之间存在显著差异，助产士在更大程度上同意这一表述（p = 0.033）。与普通人群相比，助产士和产科医生的剖宫产分娩方式没有显著差异。1975年出生的助产士器械助产率与广大人群相比显著较低（p < 0.05）。
多年来，剖宫产指征有所增加。这种增加在不同时期阅读的教科书中以及在1955年和1975年出生的瑞典助产士和产科医生中都有体现。
