Barasinski Chloé, Debost-Legrand Anne, Lemery Didier, Vendittelli Françoise
Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France.
Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France; Réseau de Santé en Périnatalité d'Auvergne, F-63000 Clermont-Ferrand, France.
Midwifery. 2018 May;60:48-55. doi: 10.1016/j.midw.2018.02.001. Epub 2018 Feb 8.
the principal objective of our study was to describe the practices reported by French midwives during the active second stage of labor (expulsion phase).
this cross-sectional Internet survey questioned French midwives who attended at least one childbirth in 2013.
this open survey was posted on a website from June 15 through December 1, 2014.
1496 midwives from 377 maternity units participated in the study.
the midwives most often reported suggesting horizontal positions during the active second stage (supine with footholds, lithotomy, lithotomy with knees turned in, or lateral positions). Non-horizontal positions were more often proposed by midwives in level I units (p<0.0001). Almost half the midwives responding (46.4%), especially those working in level III units (51.1%, p = 0.006), advised Valsalva pushing. The mean maximum pushing time was 35.3 minutes±12.8 minutes. Nearly all the midwives favored the 'hands on' technique at childbirth (91.4%), and 24% reported using warm compresses on the perineum at childbirth.
most midwives advised horizontal positions for childbirth. The practices of French midwives differed as a function of where they worked. The midwives, especially those in level III facilities, reported that they cannot always ensure 'physiological childbirth'.
the practices of French midwives must become more evidence-based. The development of professional guidelines for midwives in France appears essential. This study also helps to prioritise national training for midwives.
我们研究的主要目的是描述法国助产士在产程活跃第二期（娩出期）所采用的方法。
这项横断面互联网调查询问了2013年至少接生过一名婴儿的法国助产士。
这项开放式调查于2014年6月15日至12月1日发布在一个网站上。
来自377个产科单位的1496名助产士参与了该研究。
助产士最常报告在产程活跃第二期建议采用水平体位（仰卧并使用脚蹬、截石位、双膝内翻的截石位或侧卧位）。一级单位的助产士更常建议采用非水平体位（p<0.0001）。近一半做出回应的助产士（46.4%），尤其是在三级单位工作的助产士（51.1%，p = 0.006），建议产妇在分娩时屏气用力。平均最大用力时间为35.3分钟±12.8分钟。几乎所有助产士在分娩时都倾向于“手把手”技术（91.4%），24%的助产士报告在分娩时会对会阴进行热敷。
大多数助产士建议分娩时采用水平体位。法国助产士的方法因工作地点而异。助产士，尤其是三级医疗机构的助产士报告称，他们无法始终确保“生理性分娩”。
法国助产士的方法必须更基于证据。制定法国助产士的专业指南似乎至关重要。这项研究还有助于确定对助产士进行国家培训的优先事项。
