University of Milano - Bicocca, School of Medicine and Surgery, Via Cadore, 48, 20900, Monza, Italy.
University of Milano - Bicocca, School of Medicine and Surgery, Via Cadore, 48, 20900, Monza, Italy.
Midwifery. 2019 Nov;78:8-15. doi: 10.1016/j.midw.2019.07.013. Epub 2019 Jul 15.
To explore midwives' experiences of the management of the second stage of labour in women with epidural analgesia.
Descriptive qualitative study using semi-structured face-to-face interviews.
Purposive sample of twelve midwives working in three Obstetric Units. Among them six were senior midwives with more than five years' experience on labour ward and six were junior midwives with less than five years' experience on labour ward.
The findings included four themes: a) timing of second stage of labour and maternal pushing; b) maternal positions and mobility; c) perspectives on epidural boluses; d) midwifery presence and support. The time 'allowed' by midwives for the passive phase of the second stage of labour ranged from zero to two hours, with some of them avoiding vaginal examinations to delay the recorded starting time of active pushing. The semi-sitting and the lithotomy positions were the most used respectively in labour and at birth. Some midwives encouraged the kneeling position or the lateral position. Regarding the management of the epidural bolus during the second stage of labour, the interviewees' opinions were divided between favourable and unfavourable to the administration of analgesic boluses after the full cervical dilatation. Midwives reported their experiences of providing different care to women with epidural analgesia when compared to women without epidural, mainly due to a more medicalised approach and the midwives' sense of 'usefulness' when caring for women not experiencing labour pain.
To our knowledge, this was the first study on this topic conducted in an Italian setting. Despite the consistent body of evidence on the effects of epidural analgesia in the second stage on birth outcomes, the lack of clear guidelines, the presence of different hospital protocols and Obstetricians' opinion, introduce uncertainty in midwifery practice and lead midwives with feelings of 'uselessness'. Across the four themes, midwives frequently had to negotiate a space for their professional autonomy with other healthcare professionals, whilst adhering to the Obstetric Units' protocols. An influencing factor on the care provided to women with epidural was the years of midwife's experience on labour ward. Further research and the development of comprehensive midwifery care guidelines on the management of the second stage of labour in women with an epidural analgesia appears essential.
探讨导乐分娩时，助产士在产妇硬膜外分娩镇痛管理方面的经验。
采用半结构式面对面访谈的描述性定性研究。
在三家产科病房工作的 12 名助产士。其中 6 名是有 5 年以上产房工作经验的资深助产士，6 名是有 5 年以下产房工作经验的初级助产士。
研究结果包括四个主题：a）第二产程和产妇用力的时机；b）产妇的姿势和活动度；c）对硬膜外追加剂量的看法；d）助产士的存在和支持。助产士允许第二产程的被动阶段的时间从 0 到 2 小时不等，其中一些人避免阴道检查以延迟活跃期开始的记录时间。半坐卧位和截石位分别是分娩中和分娩时最常用的体位。一些助产士鼓励产妇采用跪姿或侧卧位。关于第二产程硬膜外追加剂量的管理，受访者的意见在完全宫颈扩张后给予镇痛追加剂量有利和不利之间存在分歧。助产士报告了与没有硬膜外分娩镇痛的产妇相比，为硬膜外分娩镇痛的产妇提供不同护理的经验，主要是由于采用了更具医学化的方法以及助产士在照顾不经历分娩疼痛的产妇时的“有用感”。
据我们所知，这是在意大利进行的关于该主题的第一项研究。尽管硬膜外分娩镇痛对第二产程分娩结局的影响有大量证据，但缺乏明确的指南、不同医院方案和产科医生的意见，给助产士实践带来了不确定性，并导致助产士感到“无用”。在这四个主题中，助产士经常不得不在坚持产科病房方案的同时，与其他医疗保健专业人员协商他们的专业自主权空间。对有硬膜外分娩镇痛的产妇护理的一个影响因素是助产士在产房工作的年限。进一步的研究和制定关于硬膜外分娩镇痛产妇第二产程管理的全面助产士护理指南显得至关重要。
