Butler Michelle M
Department of Family Practice | Midwifery Program, University of British Columbia, 320 - 5950 University Boulevard, Vancouver, BC, V6T1Z3, Canada.
Faculty of Science and Health, Dublin City University, Glasnevin, Dublin 9, Ireland.
BMC Pregnancy Childbirth. 2017 Jun 5;17(1):168. doi: 10.1186/s12884-017-1323-7.
Rates of normal birth have been declining steadily over the past 20 years, despite the evidence of the benefits to mother and baby. This is most obvious in steadily increasing caesarean section rates across countries and studies of the factors involved suggest it may be more to do with the organization of maternity care and the preferences of healthcare providers than changes in maternal or demographic conditions. The proportion of women in British Columbia (BC) receiving care from a midwife continues to grow and there is a particular focus on promoting and supporting normal pregnancy and birth in the midwifery philosophy of care. In BC, women receiving care from a midwife are less likely to have a caesarean section and other birth interventions.
An interpretive approach, based on interpretive phenomenology was used to explore the experiences of midwives in BC of normal birth and the strategies that they use to keep birth normal. Fourteen experienced midwives were purposively selected from across the range of practice, geographical, and rural/urban contexts to participate in depth interviews. Data were analyzed using Thematic Network Analysis.
Seven key themes were identified in the data: working with women from the early pregnancy, informing choice, the birth environment, careful watching and waiting, managing early labour, helping the woman to cope with labour, and tools in the tool kit.
Midwives in BC work closely with women from early pregnancy to prepare them for a normal birth, and as "instruments of care" they adopt a range of approaches to support women to achieve this. The emphasis on continuity of care in the BC model of midwifery care plays a vital role in this.
尽管有证据表明正常分娩对母婴有益，但在过去20年里，正常分娩率一直在稳步下降。这在各国剖宫产率稳步上升的情况中最为明显，对相关因素的研究表明，这可能更多地与产科护理的组织方式以及医疗服务提供者的偏好有关，而非产妇或人口状况的变化。不列颠哥伦比亚省（BC）接受助产士护理的女性比例持续增长，并且在助产护理理念中特别注重促进和支持正常妊娠与分娩。在BC省，接受助产士护理的女性进行剖宫产和其他分娩干预的可能性较小。
采用基于解释现象学的解释性方法，探讨BC省助产士对正常分娩的体验以及她们保持分娩正常所采用的策略。从不同执业范围、地理区域以及农村/城市环境中，有目的地挑选了14名经验丰富的助产士参与深度访谈。使用主题网络分析法对数据进行分析。
数据中确定了七个关键主题：从早孕起就与女性合作、提供选择信息、分娩环境、密切观察与等待、处理早期分娩、帮助女性应对分娩以及工具包中的工具。
BC省的助产士从早孕起就与女性密切合作，为她们的正常分娩做好准备，并且作为“护理工具”，她们采用一系列方法来支持女性实现这一目标。BC省助产护理模式中对连续性护理的强调在其中起着至关重要的作用。
