Voon Shi Tian, Lay Julie Tay Suan, San Wilson Tam Wai, Shorey Shefaly, Lin Serena Koh Siew
Division of Nursing, Singapore General Hospital, Singapore.
Division of Nursing, Delivery Suite, KK Women's and Children's Hospital, Singapore.
Midwifery. 2017 Oct;53:71-79. doi: 10.1016/j.midw.2017.07.010. Epub 2017 Jul 18.
to examine the maternal and neonatal outcomes of low-risk women receiving midwife-led care and obstetrician-led care. DESIGN, SETTING,&PARTICIPANTS: a retrospective cohort study design was used. Data were collected from a large tertiary maternity hospital in Singapore. This involved a medical record review of 368 women who had singleton, normal to low-risk, term pregnancy, and received midwife-led care and obstetrician-led care between 2013 to 2014.
a data extraction tool was used to solicit information on the outcome measures, including duration of labour, mode of delivery, episiotomy, and 5-minutes Apgar score (<7). Descriptive statistics were used to summarise the women's 'characteristics. χ and independent sample t-test were used to assess the differences in demographics and birth outcomes. Multiple linear and logistic regressions were used to examine the difference between the two comparison groups after adjusted for potential confounders.
statistically significant differences (p<0.05) between the midwife-led care group and the obstetrician-led care group in terms of the total duration of labour and total antenatal visits were found. No statistically significant differences were observed for mode of delivery, episiotomy, intrapartum pain management, labour augmentation, labour induction, postpartum haemorrhage, perineal trauma, birth status, 5-minutes Apgar score (<7), low birth weight (<2500g), and neonatal admission to intensive care units between the midwife-led care group and the obstetrician-led care group.
while interventions such as episiotomies and labour augmentation were more common in the midwife-led care group, no significant differences were found for most of the outcome measures between the two maternity groups except for total antenatal visits and duration of labour. Findings suggest that midwife-led care is as safe and effective as obstetrician-led care in achieving optimal birth outcomes, with no higher risk of adversities for low-risk women. Additional studies are necessary to continuously evaluate midwife-led care and to promote normal birth and reduce excessive use of obstetric procedures.
the provision of midwife-led care should continue to be extended as an additional choice in maternity care for women with low-risk pregnancies. Professional staff development with continuous education is needed to clear misconceptions about midwife-led care and to promote awareness in current practice guidelines. Prospective evaluation of midwife-led care will be beneficial in informing policies and practise guidelines.
探讨接受助产士主导护理和产科医生主导护理的低风险女性的孕产妇和新生儿结局。
设计、地点和参与者：采用回顾性队列研究设计。数据收集自新加坡一家大型三级妇产医院。这涉及对368名单胎、正常至低风险、足月妊娠且在2013年至2014年期间接受助产士主导护理和产科医生主导护理的女性的病历审查。
使用数据提取工具获取关于结局指标的信息，包括产程、分娩方式、会阴切开术和5分钟阿氏评分（<7分）。描述性统计用于总结女性的特征。χ²检验和独立样本t检验用于评估人口统计学和出生结局的差异。多元线性回归和逻辑回归用于在调整潜在混杂因素后检验两个比较组之间的差异。
发现助产士主导护理组和产科医生主导护理组在总产程和产前检查总次数方面存在统计学显著差异（p<0.05）。在分娩方式、会阴切开术、产时疼痛管理、引产、催产、产后出血、会阴创伤、出生状况、5分钟阿氏评分（<7分）、低出生体重（<2500g）以及新生儿入住重症监护病房方面，助产士主导护理组和产科医生主导护理组之间未观察到统计学显著差异。
虽然会阴切开术和引产等干预措施在助产士主导护理组中更为常见，但除产前检查总次数和产程外，两个产科组在大多数结局指标上未发现显著差异。研究结果表明，在实现最佳出生结局方面，助产士主导护理与产科医生主导护理一样安全有效，低风险女性面临的不良风险并不更高。需要进一步研究以持续评估助产士主导护理，并促进自然分娩和减少产科手术的过度使用。
应继续扩大提供助产士主导护理，作为低风险妊娠女性产科护理的额外选择。需要通过持续教育进行专业人员培训，以消除对助产士主导护理的误解，并提高对当前实践指南的认识。对助产士主导护理进行前瞻性评估将有助于制定政策和实践指南。
