Department of Women, Children, and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois.
University of Illinois Hospital, Chicago, Illinois.
J Midwifery Womens Health. 2020 Sep;65(5):621-626. doi: 10.1111/jmwh.13141. Epub 2020 Aug 4.
A calculator estimating likelihood of vaginal birth after cesarean (VBAC) has been promoted by the Society for Maternal-Fetal Medicine, but little is known about how it is used and perceived in practice. Cutoffs for prohibiting labor after cesarean are discouraged by the calculator's developers, but such uses may be widespread. The purpose of this study was to determine how calculators predicting VBAC are used and perceived in midwifery practices.
Certified nurse-midwives and certified midwives currently providing care for labor after cesarean were surveyed between January 17, 2019, and February 7, 2019. Quantitative and text data were collected regarding the uses and perceptions of calculators among midwives and their colleagues. We compared these findings with midwives' perceptions of their ability to accommodate patient wishes for labor after cesarean. We used descriptive content analysis to evaluate themes occurring in text responses.
There were 1305 valid responses. A requirement to use calculator scores for patient counseling was reported by 527 (40.4%) of responding midwives. Over 1 in 5 midwives reported that scores were used to discourage or prohibit labor after cesarean. Almost half reported some or strong disagreement with physician colleagues regarding calculator use. Interprofessional agreement and disagreement centered on how scores are used to direct clinical care or restrict patient options. Calculator scores were used in more than twice as many midwives' practices to discourage rather than encourage labor after cesarean. Descriptive analysis of text revealed 4 themes regarding calculators: inconsistent use, information counseling, informed consent, and influence patient management or options.
Calculators predicting likelihood of VBAC success are widely used in midwifery settings and are more often used to discourage than to encourage labor after cesarean. Midwives reported both directive and nondirective counseling based on calculator scores.
母胎医学会(Society for Maternal-Fetal Medicine)推广了一种用于预测剖宫产术后阴道分娩（VBAC）可能性的计算器，但对于其在实践中的使用方式和认知程度知之甚少。计算器的开发者不鼓励使用其设定的剖宫产术后禁止分娩的界限，但这种用法可能非常普遍。本研究旨在确定在助产实践中，预测 VBAC 的计算器是如何使用和被感知的。
在 2019 年 1 月 17 日至 2019 年 2 月 7 日期间，对目前提供剖宫产术后分娩护理的注册护士助产士和注册助产士进行了调查。收集了有关助产士及其同事对计算器使用情况和认知的定量和文本数据。我们将这些发现与助产士对满足患者剖宫产术后分娩意愿的能力的看法进行了比较。我们使用描述性内容分析来评估文本回复中出现的主题。
共收到 1305 份有效回复。527 名（40.4%）应答助产士报告需要使用计算器分数为患者提供咨询。超过 1/5 的助产士报告说，分数被用于劝阻或禁止剖宫产术后分娩。近一半的人报告说，他们与医生同事在计算器使用方面存在一些或强烈的分歧。专业人员之间的一致和分歧集中在如何使用分数来指导临床护理或限制患者的选择。在更多的助产实践中，计算器分数被用来劝阻而不是鼓励剖宫产术后分娩。对文本的描述性分析揭示了计算器的 4 个主题：使用不一致、信息咨询、知情同意以及影响患者管理或选择。
预测 VBAC 成功率的计算器在助产实践中广泛使用，并且更常用于劝阻而不是鼓励剖宫产术后分娩。助产士根据计算器分数报告了直接和非直接的咨询。
