University of Pittsburgh Medical Center.
Department of Health Promotion and Development, University of Pittsburgh, School of Nursing, 440 Victoria Building, 3600 Victoria Street, Pittsburgh, PA 15261, USA.
Women Birth. 2021 May;34(3):e279-e285. doi: 10.1016/j.wombi.2020.04.004. Epub 2020 May 18.
Complications for newborns and postpartum clients in the hospital are more frequent after a prolonged second stage of labour. Midwives in community settings have little research to guide management in their settings.
We explored how US birth centre midwives identify onset of second stage of labour and determine when to transfer clients to the hospital for prolonged second stage.
Ethnographic interviews of midwives with at least 2 years' experience in birth centres and participant observation of birth centre care.
We interviewed 21 midwives (18 CNMs, 3 CPMs/equivalent) from 18 birth centres in 11 US states, 45% with hospital practice privileges. Midwives relied on and engaged in embodied practice in evaluating each labour and making decisions concerning management of labour. Midwives considered time a useful but limited measure as a guiding factor in management. Though ideas of time and progress do play an important role in the decision-making process of midwives, their usefulness is limited due to the continual, multifactorial, and multisensory nature of the assessment. Relationship with the transfer hospital structured midwives' decision-making about transfers.
DISCUSSION & CONCLUSION: These findings can inform future robust multivariate evaluation of factors, including but not limited to time, in guidelines for management of second stage of labour. Optimal management may require formal consideration of more than just time and parity. Our findings also suggest the need for evaluation of how structural issues involving hospital privileges for midwives and relationships between birth centre and hospital staff affect the well-being of childbearing families.
第二产程延长会增加医院中新生儿和产后客户的并发症。社区环境中的助产士几乎没有研究可以指导他们在该环境中的管理。
我们探讨了美国分娩中心的助产士如何识别第二产程的开始，并确定何时将客户转移到医院进行第二产程延长。
对至少有 2 年分娩中心经验的助产士进行人种学访谈，并对分娩中心护理进行参与者观察。
我们采访了来自美国 11 个州的 18 个分娩中心的 21 名助产士（18 名 CNM，3 名 CPM/同等学历），其中 45% 拥有在医院执业的特权。助产士依靠并参与了身体实践，以评估每个分娩并决定如何管理分娩。助产士认为时间是一种有用但有限的管理指导因素。虽然时间和进度的概念在助产士决策过程中确实起着重要作用，但由于评估的持续、多因素和多感官性质，其有用性是有限的。与转院的关系结构决定了助产士关于转院的决策。
这些发现可以为未来对管理第二产程的指南中包括但不限于时间的因素进行稳健的多变量评估提供信息。最佳管理可能需要正式考虑不仅仅是时间和经产次。我们的研究结果还表明，需要评估涉及助产士医院特权的结构问题以及分娩中心和医院工作人员之间的关系如何影响生育家庭的福祉。
