Patterson Jean, Foureur Maralyn, Skinner Joan
School of Midwifery, Otago Polytechnic, Forth Street, Private Bag 1910, 9054 Dunedin, New Zealand.
Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Level 8, Building 10, City Campus, PO Box 123, Broadway, NSW 2007, Australia.
Midwifery. 2017 Sep;52:49-56. doi: 10.1016/j.midw.2017.05.014. Epub 2017 May 29.
Birth in primary midwife-led maternity units has been demonstrated to be a safe choice for well women anticipating a normal birth. The incidence of serious perinatal outcomes for these women is comparable to similarly low risk women, who choose to birth in hospital. New Zealand women have a choice of Lead Maternity Carer (LMC) and birthplace; home, primary birthing unit, or a base hospital, though not all women may have all these choices available locally. Women in rural and rural remote areas can also choose to birth in their rural primary maternity unit. A percentage of these women (approx. 15-17%) will require transfer during labour, an event which can cause distress and often loss of midwifery continuity of care.
To explore retrospectively the choice of birth place decisions and the labour and birth experiences of a sample of women resident in remotely zoned, rural areas of the lower South Island of New Zealand.
A purposive sample of women living in remote rural areas, recruited by advertising in local newspapers and flyers. Individual semi-structured interviews were digitally recorded using a pragmatic interpretive approach. The data (transcripts and field notes) were analysed using thematic and content analysis. Ethical approval was obtained from the Health and Disability Ethics Committee (HEDC) MEC/06/05/045.
Thirteen women consented to participate. Each was resident in a remote rural area having given birth in the previous 18 months. The women had been well during their pregnancies and at the onset of labour had anticipated a spontaneous vaginal birth.
Rural remote zoned areas in Otago and Southland in the South Island of New Zealand FINDINGS: Five women planned to birth in a regional hospital and eight chose their nearest rural primary maternity unit. All of the women were aware of the possibility of transfer and had made their decision about their birthplace based on their perception of their personal safety, and in consideration of their distance from specialist care. Themes included, deciding about the safest place to give birth; making the decision to transfer; experiencing transfer in labour, and reflecting on their birth experience and considering future birthplace choices.
The experiences of the women show that for some, distance from a base hospital influences their place of birth decisions in remote rural areas of New Zealand and increases the distress for those needing to transfer over large distances. These experiences can result in women choosing, or needing to make different choices for subsequent births; the consequences of which impact on the future sustainability of midwifery services in remote rural areas, a challenge which resonates with maternity service provision internationally. While choices about birth place cannot be reliably predicted, creative solutions are needed to provide rural midwifery care and birth options for women and more timely and efficient transfer services when required.
对于预期正常分娩的健康女性而言，在由初级助产士主导的产科病房分娩已被证明是一种安全的选择。这些女性发生严重围产期不良结局的发生率与选择在医院分娩的低风险女性相当。新西兰女性可以选择主要孕产护理人员（LMC）和分娩地点；家中、初级分娩单元或基础医院，不过并非所有女性在当地都能有这些选择。农村及偏远农村地区的女性也可选择在其农村初级产科病房分娩。这些女性中有一定比例（约15% - 17%）在分娩过程中需要转诊，这一情况可能会导致困扰，且常常会使助产护理的连续性中断。
回顾性探究新西兰南岛偏远农村地区部分女性的分娩地点选择决定以及她们的分娩经历。
通过在当地报纸和传单上刊登广告，选取偏远农村地区的女性作为有目的的样本。采用务实的解释性方法对个体进行半结构化访谈，并进行数字录音。使用主题分析和内容分析对数据（文字记录和现场笔记）进行分析。已获得健康与残疾伦理委员会（HEDC）MEC/06/05/045的伦理批准。
13名女性同意参与。她们均居住在偏远农村地区，且在过去18个月内分娩。这些女性在孕期状况良好，临产前预期会自然阴道分娩。
新西兰南岛奥塔哥和南地的偏远农村地区
5名女性计划在地区医院分娩，8名选择了最近的农村初级产科病房。所有女性都知晓转诊的可能性，且她们基于对自身安全的认知以及与专科护理机构的距离做出了分娩地点的决定。主题包括：决定最安全的分娩地点；做出转诊决定；经历分娩过程中的转诊；反思她们的分娩经历并考虑未来的分娩地点选择。
这些女性的经历表明，对于一些人来说，与基础医院的距离会影响她们在新西兰偏远农村地区的分娩地点决定，并增加那些需要长途转诊的女性的困扰。这些经历可能导致女性在后续分娩时选择或需要做出不同的选择；其后果会影响偏远农村地区助产服务未来的可持续性，这一挑战在国际产服务提供中也存在。虽然无法可靠预测分娩地点的选择，但需要创造性的解决方案，为女性提供农村助产护理和分娩选择，并在需要时提供更及时、高效的转诊服务。
