School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Qld, 4558, Australia.
BMC Pregnancy Childbirth. 2019 Apr 27;19(1):140. doi: 10.1186/s12884-019-2288-5.
Previous research examining the birth of the placenta has focussed on quantitative outcomes comparing active and expectant (physiological) management. However, it is also important to understand women's experiences of birthing the placenta.
The participant group consisted of 11 women who had expectant management, eight who had active management and one who was unsure. Participants were interviewed in-depth and the data analysed using thematic analysis.
Seven themes were identified in the data relating to before, during and after the birth of the placenta. Before birth themes focused on making decisions and included 'doing the research' and 'natural birth'. During the birth of the placenta themes were 'boundaries of time', 'focusing on baby' and 'sensations'. After the birth themes consisted of 'looking' and 'keeping'.
Most of the women considered a physiological birth of the placenta to be an intrinsic element of natural birth. Active management was considered to be an intervention used if complications occurred. In contrast, women who chose active management did not consider the placenta to be an important element of natural birth, and chose active management in order to prevent complications. Decisions about birthing the placenta were informed by Internet sources and previous personal experiences rather than care providers. During the birth of the placenta care providers managed the boundaries of time whilst women focused on their baby. The sensations women described were consistent across both types of management. Women valued seeing their placenta and having the opportunity to keep it, and placenta encapsulation was popular. The findings of this study contribute the experiences of women to the body of knowledge informing practice during the birth of the placenta.
既往研究多聚焦于对比活跃管理和期待管理（生理性管理）的胎盘娩出的量化结局，而理解产妇娩出胎盘的体验也同样重要。
研究纳入 11 名接受期待管理、8 名接受活跃管理和 1 名不确定管理的产妇。对所有产妇进行深入访谈，采用主题分析法对资料进行分析。
本研究共识别出 7 个主题，涉及胎盘娩出前、娩出中和娩出后的相关体验。胎盘娩出前的主题主要为决策制定，包括“做研究”和“自然分娩”；胎盘娩出期间的主题为“时间界限”“关注宝宝”和“感觉”；胎盘娩出后的主题为“观察”和“保留”。
大多数产妇认为生理性胎盘娩出是自然分娩的固有组成部分。如果发生并发症，则会采取积极的管理措施。相比之下，选择积极管理的产妇不认为胎盘是自然分娩的重要组成部分，而是为了预防并发症而选择积极管理。关于胎盘娩出的决策受网络资源和个人既往经验的影响，而非医护人员。在胎盘娩出过程中，医护人员管理时间界限，而产妇专注于自己的宝宝。两种管理方式下，产妇描述的感觉是一致的。产妇非常重视观察胎盘并保留胎盘，胎盘封存技术也广受欢迎。本研究的结果丰富了产妇胎盘娩出体验的相关知识，为胎盘娩出的实践提供了依据。
