Afshar Yalda, Mei Jenny Y, Gregory Kimberly D, Kilpatrick Sarah J, Esakoff Tania F
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Birth. 2018 Mar;45(1):43-49. doi: 10.1111/birt.12320. Epub 2017 Nov 2.
To examine whether the presence of a birth plan was associated with mode of delivery, obstetrical interventions, and patient satisfaction.
This was a prospective cohort study of singleton pregnancies greater than 34 weeks' gestation powered to evaluate a difference in mode of delivery. Maternal characteristics, antenatal factors, neonatal characteristics, and patient satisfaction measures were compared between groups. Differences between groups were analyzed using chi-squared for categorical variables, Fisher exact test for dichotomous variables, and Wilcoxon rank sum test for continuous or ordinal variables.
Three hundred women were recruited: 143 (48%) had a birth plan. There was no significant difference in the risk of cesarean delivery for women with a birth plan compared with those without a birth plan (21% vs 16%, adjusted odds ratio [adjOR] 1.11 [95% confidence interval (CI) 0.61-2.04]). Women with a birth plan were 28% less likely to receive oxytocin (P < .01), 29% less likely to undergo artificial rupture of membranes (P < .01), and 31% less likely to have an epidural (P < .01). There was no difference in the length of labor (P = .12). Women with a birth plan were less satisfied (P < .01) and felt less in control (P < .01) of their birth experience than those without a birth plan.
Women with and without a birth plan had similar odds of cesarean delivery. Though they had fewer obstetrical interventions, they were less satisfied with their birth experience, compared with women without birth plans. Further research is needed to understand how to improve childbirth-related patient satisfaction.
探讨分娩计划的存在是否与分娩方式、产科干预措施及患者满意度相关。
这是一项对孕周大于34周的单胎妊娠进行的前瞻性队列研究，旨在评估分娩方式的差异。比较了两组之间的产妇特征、产前因素、新生儿特征及患者满意度指标。使用卡方检验分析分类变量组间差异，使用Fisher精确检验分析二分变量组间差异，使用Wilcoxon秩和检验分析连续或有序变量组间差异。
招募了300名女性：143名（48%）有分娩计划。有分娩计划的女性与无分娩计划的女性相比，剖宫产风险无显著差异（21%对16%，调整优势比[adjOR]为1.11[95%置信区间(CI)0.61 - 2.04]）。有分娩计划的女性接受缩宫素的可能性降低28%（P <.01），行人工破膜的可能性降低29%（P <.01），接受硬膜外麻醉的可能性降低31%（P <.01）。产程长度无差异（P =.12）。与无分娩计划的女性相比，有分娩计划的女性对分娩经历的满意度较低（P <.01），且感觉对分娩经历的掌控感较差（P <.01）。
有和没有分娩计划的女性剖宫产几率相似。尽管她们接受的产科干预较少，但与没有分娩计划的女性相比，她们对分娩经历的满意度较低。需要进一步研究以了解如何提高与分娩相关的患者满意度。
