Smeltzer Suzanne C, Wint Amy J, Ecker Jeffrey L, Iezzoni Lisa I
Center for Nursing Research, Villanova University College of Nursing, Villanova, PA, USA.
Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA.
Birth. 2017 Dec;44(4):315-324. doi: 10.1111/birt.12296. Epub 2017 Jun 8.
Although many women with physical disabilities report poor quality reproductive health care, little research has addressed labor, delivery, and anesthesia experiences of these women. This study was conducted to explore these experiences in women with significant mobility disabilities.
A qualitative descriptive study was conducted with 22 women from the United States who had delivered newborns within the prior 10 years. All had significant mobility disabilities. Two-hour, in-depth telephone interviews were conducted using a semistructured, open-ended interview protocol, which addressed many topics, including labor, delivery, and anesthesia experiences. We recruited most participants through social networks, interviewing women from 17 states. Conventional content analysis, facilitated by NVivo software, was used to identify major themes.
The mean age of women was 34.8 ± 5.3 years. Most women were white, college educated, and used wheeled mobility aids. Four key themes emerged from participants' narratives of laboring and giving birth with a disability. These included women's preferences for type of delivery, clinicians and some women expected no labor pain, fears prompting active advocacy, and positive experiences. As participants discussed their experiences with anesthesia, four additional themes were identified: importance of consultation with the anesthesia team, decisions about epidural/spinal vs general anesthesia, failed epidural with repeated efforts, and fear of injury related to anesthesia.
The responses of women in this study suggest that there is need to make intrapartum care better for women with physical disabilities and to improve their experiences with labor, birth, and obstetric anesthesia care.
尽管许多身体残疾的女性报告称生殖健康护理质量较差，但针对这些女性的分娩及麻醉经历的研究却很少。本研究旨在探讨重度行动不便女性的这些经历。
对22名来自美国且在过去10年内分娩过新生儿的女性进行了一项定性描述性研究。所有女性均有重度行动不便。使用半结构化、开放式访谈方案进行了两小时的深入电话访谈，访谈涉及诸多主题，包括分娩及麻醉经历。我们通过社交网络招募了大多数参与者，采访了来自17个州的女性。在NVivo软件的辅助下，采用常规内容分析法来确定主要主题。
女性的平均年龄为34.8 ± 5.3岁。大多数女性为白人，受过大学教育，且使用轮椅作为行动辅助工具。参与者关于残疾状态下分娩的叙述中出现了四个关键主题。这些主题包括女性对分娩方式的偏好、临床医生以及一些女性期望无痛分娩、促使积极维权的恐惧以及积极的经历。当参与者讨论她们的麻醉经历时，又确定了另外四个主题：与麻醉团队协商的重要性、关于硬膜外/脊髓麻醉与全身麻醉的决策、多次尝试硬膜外麻醉失败以及对与麻醉相关损伤的恐惧。
本研究中女性的回答表明，有必要改善身体残疾女性的产时护理，并提升她们在分娩和产科麻醉护理方面的体验。
