J Midwifery Womens Health. 2018 Jul;63(4):446-454. doi: 10.1111/jmwh.12728. Epub 2018 Jan 31.
Midwives and physicians incorporate their knowledge, experiences, and other variables in making clinical decisions. Variations in the management of the third stage of labor may be a result of variables that influence providers' decision making. The purpose of this study was to describe variables that influence US midwives' and physicians' management of the third stage of labor.
A randomly selected national sample of certified nurse-midwives and certified midwives, certified professional midwives, obstetricians, and family physicians was surveyed about the extent to which maternal characteristics, maternal history, and current birth characteristics influence their third-stage management. The extent of influence was defined in terms of always to never altering management. Descriptive summaries, group comparisons, and partial correlations were used to determine differences in influences between midwives and physicians. One free-text question was analyzed using qualitative methods.
A total of 1243 clinicians responded. There was considerable variability in the response patterns in that the same variable was reported to always alter management during the third stage of labor for some participants yet did not influence the management practices of others at all. Differences between responses from midwives and physicians were explored as a possible explanation for some of the variability. In response to the free-text inquiry about variables that most influenced changes in participants' usual management of the third stage, the participants most often included active bleeding, current recommendations or guidelines, and maternal or family preferences.
This study identifies variables reported as influencing clinical decision making during the third stage of labor. Therefore, these variables are important to consider when evaluating interventions and outcomes related to management of the third stage of labor and any attempts to design new interventions. The findings are descriptive of practice; they are not intended to guide changes in practice.
助产士和医生在做出临床决策时会综合运用他们的知识、经验和其他变量。第三产程管理的差异可能是影响提供者决策的变量的结果。本研究的目的是描述影响美国助产士和医生管理第三产程的变量。
对随机选择的注册护士助产士和注册助产士、认证专业助产士、产科医生和家庭医生进行了一项调查，内容是产妇特征、产妇病史和当前分娩特征在多大程度上影响他们的第三产程管理。影响程度的定义是从不改变管理到总是改变管理。使用描述性总结、组间比较和偏相关来确定助产士和医生之间影响的差异。对一个自由文本问题进行了定性分析。
共有 1243 名临床医生做出了回应。在反应模式上存在很大的差异，即同一个变量对一些参与者来说总是会改变第三产程的管理，但对其他参与者来说根本不会影响管理实践。探索了助产士和医生之间的反应差异，以解释一些变异性。针对自由文本中关于最能影响参与者通常管理第三产程的变量的查询，参与者最常提到的是活动性出血、当前的建议或指南以及产妇或家庭的偏好。
本研究确定了报告中影响第三产程临床决策的变量。因此，在评估与第三产程管理相关的干预措施和结果以及任何尝试设计新干预措施时，这些变量很重要。研究结果描述了实践，它们并不是为了指导实践的改变。
