School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
Research in Childbirth and Health (ReaCH) Unit, UCLan THRIVE Centre, University of Central Lancashire, Preston PR1 2HE, UK; Adjunct Western Sydney University, Australia.
Women Birth. 2021 Nov;34(6):e557-e566. doi: 10.1016/j.wombi.2020.10.008. Epub 2020 Nov 8.
Organisational culture and place of birth have an impact on the variation in birth outcomes seen in different settings.
To explore how childbirth is constructed and influenced by context in three birth settings in Australia.
This ethnographic study included observations of 25 healthy women giving birth in three settings: home (9), two birth centres (10), two obstetric units (9). Individual interviews were undertaken with these women at 6-8 weeks after birth and focus groups were conducted with 37 midwives working in the three settings: homebirth (11), birth centres (10) and obstetric units (16).
All home birth participants adopted a forward leaning position for birth and no vaginal examinations occurred. In contrast, all women in the obstetric unit gave birth on a bed with at least one vaginal examination. One summary concept emerged, Philosophy of childbirth and place of birth as synergistic mechanisms of effect. This was enacted in practice through 'running the gauntlet', based on the following synthesis: For women and midwives, depending on their childbirth philosophy, place of birth is a stimulus for, or a protection from, running the gauntlet of the technocratic approach to birth. The birth centres provided an intermediate space where the complex interplay of factors influencing acceptance of, or resistance to the gauntlet were most evident.
A complex interaction exists between prevailing childbirth philosophies of women and midwives and the birth environment. Behaviours that optimise physiological birth were associated with increasing philosophical, and physical, distance from technocratic childbirth norms.
组织文化和出生地对不同环境中出生结果的差异有影响。
探索在澳大利亚的三个分娩环境中，分娩是如何通过背景构建和受到影响的。
这项民族志研究包括对三个环境中 25 名健康分娩妇女的观察：家庭（9 人）、两个分娩中心（10 人）和两个产科病房（9 人）。在分娩后 6-8 周，对这些妇女进行了个体访谈，并对在这三个环境中工作的 37 名助产士进行了焦点小组讨论：家庭分娩（11 人）、分娩中心（10 人）和产科病房（16 人）。
所有家庭分娩的参与者都采取了前倾的姿势分娩，没有进行阴道检查。相比之下，所有在产科病房分娩的妇女都在床上分娩，至少进行了一次阴道检查。一个概括性的概念出现了，即分娩哲学和分娩地点是相互作用的影响机制。这在实践中通过“穿越难关”来实施，基于以下综合：对于妇女和助产士来说，根据他们的分娩哲学，分娩地点是他们面对或避免技术主义分娩方法的刺激因素。分娩中心提供了一个中间空间，在这里，影响对难关的接受或抵制的复杂因素相互作用最为明显。
妇女和助产士的主流分娩哲学与分娩环境之间存在复杂的相互作用。促进生理分娩的行为与越来越多的哲学和物理距离与技术主义分娩规范相关。
