Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Int J Gynaecol Obstet. 2019 Apr;145(1):101-109. doi: 10.1002/ijgo.12771.
To evaluate changes in quality of care after implementing an adapted safe childbirth checklist (SCC) in Chiapas, Mexico.
A convergent mixed-methods study was conducted among 447 women in labor who attended a rural community hospital between September 1, 2016, and June 30, 2017. Logistic regression analysis was used to evaluate adherence to evidence-based practices over time, adjusting for provider. Participants were surveyed about their perceptions of care after hospital discharge. A purposefully sampled subgroup also completed in-depth interviews. Thematic analysis was performed to evaluate perceptions of care.
384 (85.9%) women were attended by staff that used the adapted SCC during delivery. Of these, 221 and 28 completed the hospital discharge survey and in-depth interview, respectively. Adherence with offering a birth companion (odds ratio [OR] 3.06, 95% CI 1.40-6.68), free choice of birth position (2.75, 1.21-6.26), and immediate skin-to-skin contact (4.53, 1.97-10.39) improved 6-8 months after implementation. Participants' perceived quality of care improved over time. Provider communication generated positive perceptions. Reprimanding women for arriving in early labor or complaining of pain generated negative perceptions.
Use of the adapted SCC improved quality of care through increased adherence with essential and respectful delivery practices.
评估在墨西哥恰帕斯州实施改良安全分娩清单（SCC）后护理质量的变化。
在 2016 年 9 月 1 日至 2017 年 6 月 30 日期间，对在一家农村社区医院分娩的 447 名妇女进行了一项收敛性混合方法研究。使用逻辑回归分析来评估随着时间的推移，在调整提供者的情况下，证据实践的依从性。在出院后，对参与者进行了关于护理认知的调查。目的抽样的亚组还完成了深入访谈。对护理认知进行了主题分析。
384 名（85.9%）由在分娩时使用改良 SCC 的工作人员照顾的妇女中，有 221 名和 28 名分别完成了医院出院调查和深入访谈。提供分娩陪伴的意愿（比值比 [OR] 3.06，95%置信区间 [CI] 1.40-6.68）、自由选择分娩姿势（2.75，1.21-6.26）和立即皮肤接触（4.53，1.97-10.39）的依从性在实施后 6-8 个月得到改善。参与者对护理质量的认知随着时间的推移而提高。提供者的沟通产生了积极的认知。责备妇女过早进入分娩或抱怨疼痛产生了负面认知。
使用改良 SCC 通过提高与基本和尊重性分娩实践的依从性来改善护理质量。
