Kennedy Holly P, Cheyney Melissa, Dahlen Hannah G, Downe Soo, Foureur Maralyn J, Homer Caroline S E, Jefford Elaine, McFadden Alison, Michel-Schuldt Michaela, Sandall Jane, Soltani Hora, Speciale Anna M, Stevens Jennifer, Vedam Saraswathi, Renfrew Mary J
Yale School of Nursing, Yale University, West Haven, CT, USA.
Oregon State University, Corvallis, OR, USA.
Birth. 2018 Sep;45(3):222-231. doi: 10.1111/birt.12361. Epub 2018 Jun 21.
Despite decades of considerable economic investment in improving the health of families and newborns world-wide, aspirations for maternal and newborn health have yet to be attained in many regions. The global turn toward recognizing the importance of positive experiences of pregnancy, intrapartum and postnatal care, and care in the first weeks of life, while continuing to work to minimize adverse outcomes, signals a critical change in the maternal and newborn health care conversation and research prioritization. This paper presents "different research questions" drawing on evidence presented in the 2014 Lancet Series on Midwifery and a research prioritization study conducted with the World Health Organization. The results indicated that future research investment in maternal and newborn health should be on "right care," which is quality care that is tailored to individuals, weighs benefits and harms, is person-centered, works across the whole continuum of care, advances equity, and is informed by evidence, including cost-effectiveness. Three inter-related research themes were identified: examination and implementation of models of care that enhance both well-being and safety; investigating and optimizing physiological, psychological, and social processes in pregnancy, childbirth, and the postnatal period; and development and validation of outcome measures that capture short and longer term well-being. New, transformative research approaches should account for the underlying social and political-economic mechanisms that enhance or constrain the well-being of women, newborns, families, and societies. Investment in research capacity and capability building across all settings is critical, but especially in those countries that bear the greatest burden of poor outcomes. We believe this call to action for investment in the three research priorities identified in this paper has the potential to achieve these benefits and to realize the ambitions of Sustainable Development Goal Three of good health and well-being for all.
尽管数十年来在全球范围内投入了大量经济资源来改善家庭和新生儿健康,但许多地区仍未实现孕产妇和新生儿健康的目标。全球已转向认识到孕期、分娩期和产后护理以及生命最初几周护理中积极体验的重要性,同时继续努力将不良后果降至最低,这标志着孕产妇和新生儿保健对话及研究重点的重大转变。本文基于《柳叶刀》2014年助产士系列文章中的证据以及与世界卫生组织共同开展的一项研究重点研究,提出了“不同的研究问题”。结果表明,未来对孕产妇和新生儿健康的研究投资应集中在“正确的护理”上,即针对个体量身定制、权衡利弊、以人为本、贯穿整个护理连续过程、促进公平且以包括成本效益在内的证据为依据的优质护理。确定了三个相互关联的研究主题:检查和实施既能增进福祉又能保障安全的护理模式;调查和优化孕期、分娩期及产后的生理、心理和社会过程;以及开发和验证能够反映短期和长期福祉的结果指标。新的变革性研究方法应考虑到增强或限制妇女、新生儿、家庭和社会福祉的潜在社会和政治经济机制。在所有环境中投资研究能力和能力建设至关重要,尤其是在那些不良后果负担最重的国家。我们相信,呼吁对本文确定的三个研究重点进行投资,有可能实现这些益处,并实现可持续发展目标三“确保所有人的健康和福祉”的宏伟目标。