School of Nursing and Midwifery, University of South Australia City East Campus, Adelaide, South Australia, Australia.
Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
Women Birth. 2021 Mar;34(2):e178-e187. doi: 10.1016/j.wombi.2020.02.019. Epub 2020 Mar 3.
A midwife's ability to fully support women's autonomy and self-determination with respect to midwifery care is often challenging. This is particularly true of water immersion for labour and birth. However, the woman's agency over what happens to her body and that of her unborn baby should be key considerations for maternity care provision.
A three phased mixed-methods study was undertaken to examine how water immersion policies and guidelines are informed. Phase three of this study captured the knowledge and experiences of Australian midwives, their support for water immersion and their experiences of using policies and guidelines to inform and facilitate the practice.
Critical, post structural, interpretive interactionism was used to examine more than 300 responses to three open-ended questions included in a survey of 233 midwives. Comment data were analysed to provide further insight, context and meaning to previously reported results.
Findings demonstrated a complex, multidimensional interplay of factors that impacted on both the midwife's ability to offer and the woman's decision to use water immersion under the themes 'the reality of the system', 'the authoritative 'others'' and 'the pseudo decision-makers'. Multiple scaffolded levels were identified, each influenced by the wider macro-socio-political landscape of Australian midwifery care.
The insight gained from examining midwives' views and opinions of water for labour and birth, has aided in contextualising previously reported results. Such insight highlights the importance of qualitative research in challenging the status quo and working towards woman-centred practice and policy.
助产士在提供助产服务时，充分支持妇女在分娩护理方面的自主权和自决权，这往往具有挑战性。在水中分娩方面尤其如此。然而，妇女对自己身体和未出生婴儿的控制应该是提供产妇护理的关键考虑因素。
进行了一项三阶段混合方法研究，以研究水浸政策和指南的制定依据。本研究的第三阶段记录了澳大利亚助产士的知识和经验、他们对水浸的支持，以及他们使用政策和指南为实践提供信息和便利的经验。
批判性、后结构、解释性相互作用主义被用于分析对包括在对 233 名助产士进行的调查中的三个开放式问题的 300 多次回答。评论数据的分析为先前报告的结果提供了进一步的见解、背景和意义。
研究结果表明，有一系列复杂的、多维度的因素相互作用，影响了助产士提供服务的能力和妇女决定使用水浸的意愿，主题包括“系统的现实”、“权威的“他人”和“伪决策者”。确定了多个有层次的因素，每个因素都受到澳大利亚助产护理的更广泛宏观社会政治环境的影响。
从检查助产士对分娩用水的看法和意见中获得的见解，有助于为以前报告的结果提供背景。这种见解突出了定性研究在挑战现状、努力实现以妇女为中心的实践和政策方面的重要性。
