Chen Chia-Chi, Lee Jia-Fu
Department of Early Childhood Care and Education, College of Nursing and Health, Kang Ning University, Taipei, Taiwan.
Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.
Tzu Chi Med J. 2020 Apr 1;32(4):373-379. doi: 10.4103/tcmj.tcmj_127_19. eCollection 2020 Oct-Dec.
The cesarean section rate in Taiwan is 32%-34%, exceeding the rate that the World Health Organization considers reasonable. A doula is a trained woman who provides physical, emotional, and informational support to pregnant women before, during, and after delivery. This study investigated the effectiveness of a new doula program in Northern Taiwan.
A quasi-experimental research design was employed. Two hundred and twenty women, divided into an experimental group with doula services and a no-doula control group receiving routine hospital care, participated in the present study. Participants' basic information was collected; the study tools were the State-Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale, labor pain visual analog scale, a labor timetable, and Mother's Level of Childbirth Satisfaction Rating Scale, which were distributed to participants during the postpartum hospitalization period.
The highest level of satisfaction was with the spouse in the control group and the doula in the experimental group. The results indicated that the childbirth process involved considerable anxiety in both groups. After delivery, the doula group exhibited a greater reduction in anxiety than the control group, but the reduction was not significant; however, a statistically significant difference was identified in the cesarean section (C/S) rate (13.0% vs. 43.2%) and normal spontaneous delivery (NSD) rate (87.0% vs. 56.8%) between the doula and control groups after controlling for the factor of primara.
Providing continuous doula program to pregnant women requiring labor support may reduce the C/S rate and increase the NSD rate. The regression model showed that the factors including high prenatal anxiety, total time needed for doula accompaniment, and epidural and analgesics use were associated with labor women receiving C/S. The factors of continuous doula support and oxytocin use were associated with receiving NSD.
台湾地区的剖宫产率为32%-34%，超过了世界卫生组织认为合理的比率。导乐是指经过培训的女性，在孕妇分娩前、分娩中和分娩后为其提供身体、情感和信息方面的支持。本研究调查了台湾北部一项新的导乐计划的效果。
采用准实验研究设计。本研究纳入了220名女性，分为接受导乐服务的实验组和接受常规医院护理的无导乐对照组。收集了参与者的基本信息；研究工具包括状态-特质焦虑量表、爱丁堡产后抑郁量表、产痛视觉模拟量表、产程时间表以及母亲分娩满意度评分量表，这些量表在产后住院期间分发给参与者。
对照组中对配偶的满意度最高，实验组中对导乐的满意度最高。结果表明，两组的分娩过程都存在相当程度的焦虑。分娩后，导乐组的焦虑减轻程度大于对照组，但差异不显著；然而，在控制初产妇因素后，导乐组和对照组在剖宫产率（13.0%对43.2%）和自然顺产率（87.0%对56.8%）上存在统计学显著差异。
为需要分娩支持的孕妇提供持续的导乐计划可能会降低剖宫产率并提高自然顺产率。回归模型显示，包括产前焦虑程度高、导乐陪伴总时长以及硬膜外麻醉和镇痛药使用等因素与接受剖宫产的产妇相关。持续的导乐支持和缩宫素使用等因素与自然顺产相关。
