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伊朗的一项定性研究:女性分娩过程中常规护理的经历及医学化的影响

Women's experiences of routine care during labour and childbirth and the influence of medicalisation: A qualitative study from Iran.

作者信息

Pazandeh Farzaneh, Potrata Barbara, Huss Reinhard, Hirst Janet, House Allan

机构信息

Infertility and Reproductive Health Research Centre (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.

出版信息

Midwifery. 2017 Oct;53:63-70. doi: 10.1016/j.midw.2017.07.001. Epub 2017 Jul 14.

Abstract

OBJECTIVE

to understand women's experiences of routine care during labor and childbirth in a medicalised context.

DESIGN

twenty-six in-depth interviews were conducted during the late postpartum period and thematic analysis was applied.

SETTING

four public hospitals in Tehran with a high rate of births, providing services to low and middle income families.

PARTICIPANTS

women who had a low risk pregnancies and gave a birth to a healthy infant by normal vaginal delivery.

FINDINGS

two main themes emerged: 'An ethos of medicalisation' which indicates that women's perception of childbirth was influenced by the medicalised context of childbirth. And 'The reality of fostered medicalisation' which illustrates the process by which interventions during labor affected women's pathway through childbirth, and how the medicalisation resulted in a birth experience which often included a preference for Caesarean Section rather than vaginal birth with multiple interventions.

IMPLICATIONS FOR PRACTICE

contextual factors such as legal issues, state's regulations and the organisational framework of maternity services foster medicalised childbirth in Tehran public hospitals. These factors influence the quality of care and should be considered in any intervention for change. The aim should be a high quality birth experience with minimal interventions during normal vaginal delivery. A midwifery model of care combining scientific evidence with empathy may address this need for change.

摘要

目的

了解在医疗化背景下女性分娩期间常规护理的经历。

设计

在产后晚期进行了26次深入访谈,并应用了主题分析。

地点

德黑兰的四家公立医院,分娩率高,为低收入和中等收入家庭提供服务。

参与者

低风险妊娠并通过正常阴道分娩产下健康婴儿的女性。

结果

出现了两个主要主题:“医疗化风气”,表明女性对分娩的认知受到分娩医疗化背景的影响;以及“强化医疗化的现实”,说明了分娩期间的干预措施如何影响女性的分娩过程,以及医疗化如何导致分娩经历,其中往往包括对剖宫产的偏好而非多次干预下 的阴道分娩。

对实践的启示

法律问题、国家法规和产科服务的组织框架等背景因素助长了德黑兰公立医院的分娩医疗化。这些因素影响护理质量,在任何变革干预中都应予以考虑。目标应该是在正常阴道分娩期间进行最少干预的高质量分娩体验。将科学证据与同理心相结合的助产护理模式可能满足这种变革需求。

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