Fenwick J, Brittain H, Gamble J
Menzies Health Institute Queensland: Maternal, Newborn and Families Research Group, School of Nursing & Midwifery, Griffith University & Gold Coast University Hospital, Australia; Women-Newborn-Children Services Gold Coast University Hospital, Maternal, Newborn and Families Research Group, Australia.
Women-Newborn-Children Services Gold Coast University Hospital, Maternal, Newborn and Families Research Group, Australia.
Women Birth. 2017 Dec;30(6):497-505. doi: 10.1016/j.wombi.2017.05.001. Epub 2017 May 15.
Reporting the outcomes for women and newborns accessing private midwives with visiting rights in Australia is important, especially since this data cannot currently be disaggregated from routinely collected perinatal data.
Mixed methods. An audit of the 'all risk' 529 women receiving private midwifery care. Data were compared with national core maternity variables using Chi square statistics. Telephone interviews were conducted with six private midwives and data analysed using thematic analysis.
Compared to national data, women with a private midwife were significantly more likely to be having a first baby (49.5% vs 43.6% p=0.007), to commence labour spontaneously (84.7% vs 52.7%, p<0.001), experience a spontaneous vaginal birth (79% vs 54%, p<0.001) and not require pharmacological pain relief (52.9% vs 23.1%, p<0.001). The caesarean section rate was significantly lower than the national rate (13% vs 32.8%, p<0.001). In addition fewer babies required admission to the Newborn Care Unit (5.1% vs 16%, p<0.001). Midwives were proud of their achievements. Continuity of care was considered fundamental to achieving quality outcomes. Midwives valued the governance processes embedded around the model.
Private midwives with access to the public system is safe. Ensuring national data collection accurately captures outcomes relative to model of care in both the public and private sector should be prioritised.
报告澳大利亚有上门服务权利的私人助产士护理下的妇女和新生儿的结局很重要，特别是因为目前这些数据无法从常规收集的围产期数据中分离出来。
1）评估昆士兰一家机构中由有上门服务权利的助产士护理的妇女和新生儿的结局；2）探讨私人助产士对促成临床结局的结构和流程的看法。
采用混合方法。对接受私人助产护理的529名“所有风险”妇女进行审计。使用卡方统计将数据与国家核心产妇变量进行比较。对六名私人助产士进行电话访谈，并使用主题分析法对数据进行分析。
与国家数据相比，有私人助产士护理的妇女更有可能是初产妇（49.5%对43.6%，p=0.007），更有可能自然发动分娩（84.7%对52.7%，p<0.001），经阴道自然分娩（79%对54%，p<0.001），且不需要药物止痛（52.9%对23.1%，p<0.001）。剖宫产率显著低于国家水平（13%对32.8%，p<0.001）。此外，需要入住新生儿护理病房的婴儿更少（5.1%对16%，p<0.001）。助产士为自己的成就感到自豪。连续性护理被认为是实现优质结局的基础。助产士重视围绕该模式的管理流程。
能接入公共系统的私人助产士是安全的。应优先确保国家数据收集准确反映公共和私营部门与护理模式相关的结局。
