首先不造成伤害 - 分娩期间的干预措施和产妇满意度：一项描述性的横断面研究。
First do no harm - interventions during labor and maternal satisfaction: a descriptive cross-sectional study.
机构信息
Obstetrics and Gynaecology Nursing Department, Karadeniz Technical University, Faculty of HealthScience, University District, Farabi Street, Ortahisar, Trabzon, Turkey.
Department of Midwifery, Kafkas University, Faculty of Health Sciences, Kars, Turkey.
出版信息
BMC Pregnancy Childbirth. 2018 Oct 24;18(1):415. doi: 10.1186/s12884-018-2054-0.
BACKGROUND
Interventions can be lifesaving when properly implemented but can also put the lives of both mother and child at risk by disrupting normal physiological childbirth when used indiscriminately without indications. Therefore, this study was performed to investigate the effect of frequent interventions during labor on maternal satisfaction and to provide evidence-based recommendations for labor management decisions.
METHODS
The study was performed in descriptive design in a state hospital in Kars, Turkey with 351 pregnant women who were recruited from the delivery ward. The data were collected using three questionnaires: a survey form containing sociodemographic and obstetric characteristics, the Scale for Measuring Maternal Satisfaction in Vaginal Birth, and an intervention observation form.
RESULTS
The average satisfaction scores of the mothers giving birth in our study were found to be low, at 139.59 ± 29.02 (≥150.5 = high satisfaction level, < 150.5 = low satisfaction level). The percentages of the interventions that were carried out were as follows: 80.6%, enema; 22.2%, perineal shaving; 70.7%, induction; 95.4%, continuous EFM; 92.3%, listening to fetal heart sounds; 72.9%, vaginal examination (two-hourly); 31.9%, amniotomy; 31.3%, medication for pain control; 74.9%, intravenous fluids; 80.3%, restricting food/liquid intake; 54.7%, palpation of contractions on the fundus; 35.0%, restriction of movement; 99.1%, vaginal irrigation with chlorhexidine; 85.5%, using a "hands on" method; 68.9%, episiotomy; 74.6%, closed glottis pushing; 43.3%, fundal pressure; 55.3%, delayed umbilical cord clamping; 86.0%, delayed skin-to-skin contact; 60.1%, controlled cord traction; 68.9%, postpartum hemorrhage control; and 27.6%, uterine massage. The satisfaction levels of those who experienced the interventions of induction, EFM, restriction of movement, two-hourly vaginal examinations, intravenous fluid, fundal pressure, episiotomy, palpation of contractions on the fundus, closed glottis pushing, delayed umbilical cord clamping, delayed skin-to-skin contact, fluid/food restriction, and of those who were not provided pharmacological pain control were found to be lower (p < 0.05).
CONCLUSION
Medical interventions carried out at high rates had a negative impact on women's childbirth experience. Therefore, a proper assessment in the light of medical evidence should be made before deciding that it is absolutely necessary to intervene in the birthing process and the interdisciplinary team should ensure that intrapartum caregivers will "first do no harm."
背景
干预措施在正确实施时可以挽救生命，但如果在没有指征的情况下不加区分地滥用，干扰正常的生理分娩，也会使母婴的生命处于危险之中。因此，本研究旨在探讨分娩过程中频繁干预对产妇满意度的影响，并为分娩管理决策提供循证建议。
方法
本研究在土耳其卡尔斯的一家州立医院进行了描述性设计，共招募了 351 名来自分娩病房的孕妇。使用三种问卷收集数据：一份包含社会人口统计学和产科特征的调查表、一份阴道分娩产妇满意度量表和一份干预观察表。
结果
研究中产妇的平均满意度评分较低，为 139.59±29.02（≥150.5=高满意度水平，<150.5=低满意度水平）。实施的干预措施百分比如下：80.6%，灌肠；22.2%，会阴剃毛；70.7%，引产；95.4%，连续胎儿监护；92.3%，听胎心音；72.9%，阴道检查（每两小时一次）；31.9%，人工破膜；31.3%，镇痛药物；74.9%，静脉输液；80.3%，限制饮食/液体摄入；54.7%，触诊宫底宫缩；35.0%，限制活动；99.1%，用洗必泰冲洗阴道；85.5%，手法检查；68.9%，会阴切开术；74.6%，闭口推胎头；43.3%，宫底按压；55.3%，延迟脐带夹闭；86.0%，延迟皮肤接触；60.1%，控制性脐带牵引；68.9%，产后出血控制；27.6%，子宫按摩。经历引产、胎儿监护、限制活动、每两小时阴道检查、静脉输液、宫底按压、会阴切开术、触诊宫底宫缩、闭口推胎头、延迟脐带夹闭、延迟皮肤接触、液体/食物限制、未接受药物镇痛的产妇满意度水平较低（p<0.05）。
结论
高频率的医疗干预措施对女性的分娩体验产生了负面影响。因此，在决定是否必须干预分娩过程之前，应根据医学证据进行适当评估，多学科团队应确保分娩过程中的护理人员“首先不造成伤害”。
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