Khresheh Reham, Almalik Mona, Owies Arwa, Barclay Lesley
Faculty of Nursing, Mutah University, Jordan.
Faculty of Nursing/ Jordan University of Science and Technology, Jordan.
Midwifery. 2018 Jun;61:1-7. doi: 10.1016/j.midw.2018.02.010. Epub 2018 Feb 15.
To investigate the feasibility and outcomes of introducing childbirth preparation programs in a sample of Maternal and Child Health centres in Jordan.
An exploratory, descriptive design, and practice- research engagement was used to implement and evaluate the proposed childbirth preparation program. Face to face interviews and field notes were used to collect data. Outcomes of pregnancy and birth were collected from interviews with women using a structured format.
Three Maternal and Child Health centres were randomly selected from the three main regions of Jordan. A convenience sample of 107 primigravid women was recruited for the implementation process. Six health staff (3 doctors and 3 midwives) also participated.
The practice- research engagement approach assisted the researchers and care providers in dealing with problems that arose during the implementation of the program. Out of the 107 women initially recruited, only 36 women completed the implementation program, with attrition rate of 65%. The main reasons for poor attendance included: difficulty in keeping contact with participants, transportation difficulties, duration of the program, health problems, antenatal follow up at a private clinic, and not having permission from husbands to attend. The effectiveness of the program was noticed through some improved pregnancy outcomes for the participants and the high satisfaction of the health professionals and women who participated. The program was effective in increasing knowledge and understanding of women regarding the different aspects of pregnancy, birth, and postnatal periods. It helped promote a trusting relationship between health professionals and women; and increased staff self confidence in providing specific and essential information to women. Women seemed to have an increased sense of control over the childbirth process, and it reinforced benefits and duration of breastfeeding and knowledge of family planning. Challenges identified by health professionals and women included: women's commitment and capacity to attend the scheduled sessions and shortage of qualified staff.
Implementing a childbirth preparation program in a developing country appears possible, successful, and effective if logistical and cultural requirements can be better addressed. This was evidenced with a high rate of participants' satisfaction (women and health care providers), and suggestions of improved pregnancy outcomes.
It is necessary to address some logistical issues of delivery and recognise the importance and limitations of current human resources. Policy makers in the Ministry of Health should consider implementation of a childbirth preparation program, as there are no existing programs. Clinical leaders, supported by researchers, should jointly consider reframing the program into a shorter more logistically acceptable delivery mode. This could be tested and evaluated.
调查在约旦的一些妇幼保健中心引入分娩准备计划的可行性及效果。
采用探索性、描述性设计以及实践 - 研究参与方式来实施和评估拟议的分娩准备计划。通过面对面访谈和实地记录收集数据。采用结构化格式从对女性的访谈中收集妊娠和分娩结局数据。
从约旦三个主要地区随机选取了三家妇幼保健中心。为实施过程招募了107名初产妇的便利样本。六名卫生工作人员（3名医生和3名助产士）也参与其中。
实践 - 研究参与方法帮助研究人员和护理人员应对计划实施过程中出现的问题。最初招募的107名女性中，只有36名女性完成了实施计划，损耗率为65%。出勤率低的主要原因包括：难以与参与者保持联系、交通困难、计划时长、健康问题、在私人诊所进行产前随访以及未获得丈夫允许参加。通过参与者一些改善的妊娠结局以及参与的卫生专业人员和女性的高度满意度，注意到了该计划的有效性。该计划有效地增加了女性对妊娠、分娩和产后不同方面的知识和理解。它有助于促进卫生专业人员与女性之间的信任关系；并增强了工作人员向女性提供特定和重要信息的自信心。女性似乎对分娩过程的控制感增强，并且强化了母乳喂养的益处和时长以及计划生育知识。卫生专业人员和女性指出的挑战包括：女性参加预定课程的意愿和能力以及合格工作人员短缺。
如果能够更好地解决后勤和文化要求，在发展中国家实施分娩准备计划似乎是可行、成功且有效的。这体现在参与者（女性和医疗保健提供者）的高满意度以及改善妊娠结局的建议中。
有必要解决一些实施方面的后勤问题，并认识到当前人力资源的重要性和局限性。卫生部的政策制定者应考虑实施分娩准备计划，因为目前尚无此类计划。临床领导者在研究人员的支持下，应共同考虑将该计划重新设计为更短且在后勤方面更可接受的实施模式。这可以进行测试和评估。
