Birth Place Lab, Department of Family Practice and Midwifery, University of British Columbia, Vancouver, British Columbia, Canada; School of Medicine, University of Sydney, Australia.
Birth Place Lab, Department of Family Practice and Midwifery, University of British Columbia, Vancouver, British Columbia, Canada.
Patient Educ Couns. 2019 Mar;102(3):586-594. doi: 10.1016/j.pec.2018.10.023. Epub 2018 Nov 2.
The Changing Childbirth in British Columbia study explored women's preferences and experiences of maternity care, including women's role in decision-making.
Following content validation by community members, we administered a cross-sectional online survey exploring novel topics, including drivers for interventions, and experiences of autonomy, respect, or mistreatment during maternity care. Using the Mothers Autonomy in Decision-Making (MADM) scale as an outcome measure in a mixed-effects analysis, we examined differential experiences by socio-demographic and prenatal risk profile, type of care provider, interventions received, and nature of communication with care providers.
A geographically representative sample of Canadian women (n = 2051) reported on 3400 pregnancies. Most women (95.2%) preferred to be the lead decision-maker during care. Patients of physicians had significantly lower autonomy (MADM) scores than midwifery clients as did women who felt pressured to accept interventions. Women who had a difference in opinion with their provider, and those who felt their provider seemed rushed reported the lowest MADM scores.
Women's autonomy is significantly altered by model of maternity care, the nature of interactions with care providers, and women's ability for self-determination.
If health professionals acquire skills in person-centred decision-making experience of autonomy among pregnant women may improve.
不列颠哥伦比亚省生育变化研究探索了女性对产妇护理的偏好和体验，包括女性在决策中的角色。
在社区成员进行内容验证后，我们进行了一项横断面在线调查，探讨了新的主题，包括干预措施的驱动因素，以及在产妇护理期间自主性、尊重或虐待的体验。我们使用决策自主性量表（MADM）作为混合效应分析的结果衡量标准，根据社会人口统计学和产前风险状况、护理提供者类型、接受的干预措施以及与护理提供者的沟通性质，检查不同的体验。
具有代表性的加拿大女性地理样本（n=2051）报告了 3400 次妊娠。大多数女性（95.2%）希望在护理期间成为主要决策者。与助产士客户相比，医生的患者自主（MADM）评分明显较低，感到有压力接受干预的女性也是如此。与提供者意见不同以及感到提供者似乎匆忙的女性报告的 MADM 评分最低。
产妇护理模式、与护理提供者互动的性质以及女性的自我决定能力显著改变了女性的自主权。
如果卫生专业人员掌握了以人为本的决策技能，孕妇的自主权体验可能会得到改善。
