Thomson Gill, Garrett Charlotte
Maternal and Infant Nutrition & Nurture Unit (MAINN), University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
Reproductive Health, Childbirth and Children's Research Team, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire PR2 9HT, UK.
Midwifery. 2019 Apr;71:63-70. doi: 10.1016/j.midw.2019.01.004. Epub 2019 Jan 15.
Despite recommendations within postnatal care guidelines, many National Health Service (NHS) hospital trusts in the UK provide an afterbirth, debriefing type service for women who have had a traumatic/distressing birth. Currently there are a lack of insights into what, how, and when this support is provided. The aim of this study was to explore afterbirth provision for women who have had a traumatic/distressing birth in NHS hospital trusts in England.
An online survey comprising forced choice and open text comments was disseminated via direct email and social media to NHS hospital trusts in England. Questions explored the types of support provided, when the support was offered, how and when the service was promoted to women, funding issues, and the role/training of service providers.
Fifty-nine respondents completed the survey, with responses from 54 different NHS hospital trusts from all geographic regions in England (40% of all trusts) included.
While the numbers of women accessing afterbirth services varied, this was often associated with a lack of dedicated funding (∼52%), and poor recording mechanisms. Some 83.3% of services had evolved based on women's needs rather than wider research/literature. Midwives are commonly the sole provider of afterbirth services (59.3%) and in 40.7% of cases the professionals who provide afterbirth support had received no specific training. In only 51.9% of trusts were 'all' women routinely given information about the service, and women were more likely to self-refer (79.6%) rather than be referred via routine screening (11.1%) or obstetric criteria (27.8%). Almost all services offered flexible access (92.6%) and many offered multiple contacts (70.3%). While most services enabled women to discuss and review their birth, only 55.6% furnished women with information on birth trauma. Approximately 89% of services referred women to specialist provision (i.e. mental health) as needed, although directing support within personal (63%) or wider support (55.6%) networks was less evident.
CONCLUSIONS/IMPLICATIONS FOR PRACTICE: While women want, and value opportunities to discuss the birth with a maternity professional following a traumatic/difficult birth, evidence suggests that resource provision is insufficient, hampered by a lack of funding, publicity, and recording systems. While further research is needed, funds to establish a well-resourced, evidence-based and well-promoted service should be prioritised.
尽管产后护理指南中有相关建议，但英国许多国民医疗服务体系（NHS）医院信托机构为经历过创伤性/痛苦分娩的女性提供产后情况汇报类服务。目前，对于该支持服务的提供内容、方式和时间缺乏深入了解。本研究旨在探讨英格兰NHS医院信托机构为经历过创伤性/痛苦分娩的女性提供产后服务的情况。
通过电子邮件和社交媒体向英格兰的NHS医院信托机构发放了一份包含强制选择和开放式文本评论的在线调查问卷。问题涉及提供的支持类型、提供支持的时间、服务向女性推广的方式和时间、资金问题以及服务提供者的角色/培训情况。
59名受访者完成了调查，其中包括来自英格兰所有地理区域的54个不同NHS医院信托机构的回复（占所有信托机构的40%）。
虽然使用产后服务的女性人数各不相同，但这通常与缺乏专项资金（约52%）以及记录机制不完善有关。约83.3%的服务是根据女性的需求发展而来，而非基于更广泛的研究/文献。助产士通常是产后服务的唯一提供者（59.3%），在40.7%的情况下，提供产后支持的专业人员未接受过专门培训。只有51.9%的信托机构会“定期”向“所有”女性提供该服务的信息，女性更倾向于自我推荐（79.6%），而非通过常规筛查（11.1%）或产科标准（27.8%）被推荐。几乎所有服务都提供灵活的接入方式（92.6%），许多服务还提供多次联系机会（70.3%）。虽然大多数服务能让女性讨论和回顾自己的分娩经历，但只有55.6%的服务为女性提供有关分娩创伤的信息。约89%的服务会根据需要将女性转介至专科服务（如心理健康服务），不过在个人（63%）或更广泛的支持网络（55.6%）内提供直接支持的情况则不太明显。
结论/对实践的启示：虽然女性希望并重视在经历创伤性/困难分娩后与产科专业人员讨论分娩情况的机会，但有证据表明资源供应不足，受到资金、宣传和记录系统缺乏的阻碍。虽然还需要进一步研究，但应优先拨款建立一个资源充足、基于证据且宣传良好的服务体系。
