澳大利亚女性为何选择不受监管的助产人员在家分娩：一项定性研究
Why do women choose an unregulated birth worker to birth at home in Australia: a qualitative study.
作者信息
Rigg Elizabeth Christine, Schmied Virginia, Peters Kath, Dahlen Hannah Grace
机构信息
School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
出版信息
BMC Pregnancy Childbirth. 2017 Mar 28;17(1):99. doi: 10.1186/s12884-017-1281-0.
BACKGROUND
In Australia the choice to birth at home is not well supported and only 0.4% of women give birth at home with a registered midwife. Recent changes to regulatory requirements for midwives have become more restrictive and there is no insurance product that covers private midwives for intrapartum care at home. Freebirth (planned birth at home with no registered health professional) with an unregulated birth worker who is not a registered midwife or doctor (e.g. Doula, ex-midwife, lay midwife etc.) appears to have increased in Australia. The aim of this study is to explore the reasons why women choose to give birth at home with an unregulated birth worker (UBW) from the perspective of women and UBWs.
METHODS
Nine participants (five women who had UBWs at their birth and four UBWs who had themselves used UBWs in the past for their births) were interviewed in-depth and the data analysed using thematic analysis.
RESULTS
Four themes were found: 'A traumatising system', 'An inflexible system'; 'Getting the best of both worlds' and 'Treated with love and respect versus the mechanical arm on the car assembly line'. Women interviewed for this study either experienced or were exposed to mainstream care, which they found traumatising. They were not able to access their preferred birth choices, which caused them to perceive the system as inflexible. They interpreted this as having no choice when choice was important to them. The motivation then became to seek alternative options of care that would more appropriately meet their needs, and help avoid repeated trauma through mainstream care.
CONCLUSION
Women who engaged UBWs viewed them as providing the best of both worlds - this was birthing at home with a knowledgeable person who was unconstrained by rules or regulations and who respected and supported the woman's philosophical view of birth. Women perceived UBWs as not only the best opportunity to achieve a natural birth but also as providing 'a safety net' in case access to emergency care was required.
背景
在澳大利亚，在家分娩的选择并未得到充分支持，只有0.4%的女性由注册助产士协助在家分娩。近期对助产士监管要求的变化变得更加严格，而且没有保险产品涵盖私人助产士在家中进行产时护理的费用。在澳大利亚，由未注册的非助产士或医生的分娩工作者（如导乐、前助产士、外行助产士等）协助的自由分娩（计划在家中分娩且无注册健康专业人员在场）似乎有所增加。本研究的目的是从女性和未注册分娩工作者的角度探讨女性选择由未注册分娩工作者协助在家分娩的原因。
方法
对九名参与者进行了深入访谈（五名在家分娩时有助产士协助的女性和四名过去自己在家分娩时有助产士协助的未注册分娩工作者），并使用主题分析法对数据进行了分析。
结果
发现了四个主题：“一个造成创伤的系统”、“一个缺乏灵活性的系统”、“两全其美”以及“被爱与尊重对待与汽车装配线上的机械手臂”。参与本研究访谈的女性要么经历过主流护理，要么接触过主流护理，她们觉得这种护理造成了创伤。她们无法获得自己偏好的分娩选择，这使她们认为该系统缺乏灵活性。她们将此理解为在选择对她们很重要时却别无选择。于是，她们的动机变成寻求更能满足自身需求的替代护理选项，并通过主流护理避免反复遭受创伤。
结论
选择未注册分娩工作者的女性认为他们能提供两全其美的服务——这意味着在家中分娩，身边是一位知识渊博且不受规章制度约束、尊重并支持女性分娩理念的人。女性认为未注册分娩工作者不仅是实现自然分娩的最佳机会，而且在需要紧急护理时还能提供“安全保障”。
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