Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, UK.
Maternity Services, Ninewells Hospital, NHS Tayside, Dundee, UK.
Birth. 2020 Dec;47(4):389-396. doi: 10.1111/birt.12514. Epub 2020 Dec 1.
Continuity of midwifery carer improves outcomes, but there is significant variation in how such schemes are implemented and evaluated cross-culturally. The Angus home birth scheme in Scotland incorporates continuity of carer throughout pregnancy, labor, birth, and the postnatal period.
Manual maternity case note review to evaluate the 80% continuity of carer and 3% planned home birth rate targets.
Of 1466 women booking for maternity care, 69 joined the scheme. Forty-four had a planned home birth (3% overall), of whom seven were originally deemed ineligible. Of the 44, eight (18%) also achieved 80% continuity of carer with the primary midwife; by including a home birth team colleague, the continuity rate rose to 73%. Women whose care achieved home birth and continuity targets had lower deprivation scores. Eligibility issues, women's changing circumstances, and data recording lapses were complicating issues.
Targets must be both feasible and meaningful and should be complemented by assessing a broad range of outcomes while viewing the scheme holistically. By expanding eligibility criteria, the home birth rate target was met; including input from a home birth team colleague in the calculation meant the continuity target was nearly met. With dedicated and competent staff, adequate resource and political support, and when considered in the round, the scheme's viability within local services was confirmed. Other generalizable learning points included the need to standardize definitions and data recording methods. Comparability across schemes helps grow the evidence base so that the links between processes and outcomes can be identified.
助产士照护的连续性可以改善母婴结局，但不同文化背景下连续性方案的实施和评估存在显著差异。苏格兰的安格斯家庭分娩计划在整个孕期、分娩和产后期间都实行助产士的连续性照护。
手工查看产妇病历以评估 80%的连续性照护和 3%的计划家庭分娩率目标的完成情况。
在 1466 名预约分娩的妇女中，有 69 名加入了该计划。44 名妇女计划在家分娩（总体比例为 3%），其中 7 名最初被认为不符合条件。在这 44 名妇女中，有 8 名（18%）与主要助产士实现了 80%的连续性照护；如果将一名家庭分娩团队的同事纳入计算，连续性照护率上升至 73%。实现家庭分娩和连续性照护目标的妇女的贫困程度得分较低。资格问题、妇女情况的变化和数据记录失误是复杂的问题。
目标必须具有可行性和意义，并应通过评估广泛的结果来补充，同时全面看待该计划。通过扩大资格标准，家庭分娩率目标得以实现；在计算中纳入家庭分娩团队同事的意见意味着连续性目标几乎得以实现。在有专门且有能力的员工、充足的资源和政治支持的情况下，并且全面考虑，该计划在当地服务中的可行性得到了确认。其他具有普遍意义的学习要点包括需要标准化定义和数据记录方法。计划之间的可比性有助于扩大证据基础，以便能够确定过程和结果之间的联系。
