Stjernholm Ylva Vladic, Charvalho Paula da Silva, Bergdahl Olga, Vladic Tomislav, Petersson Maria
Department of Women's and Children's Health Obstetric Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
Department of Women's and Children's Health, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
Front Psychol. 2021 Feb 12;12:582823. doi: 10.3389/fpsyg.2021.582823. eCollection 2021.
Obstetric labor and childbirth are mostly regarded as a physiological process, whereas social, cultural, psychological and transcendental aspects have received less attention. Labor support has been suggested to promote labor progress. The aim of this study was to investigate whether continuous labor support by a midwife promotes labor progress and vaginal delivery. A randomized controlled study at a university hospital in Sweden in 2015-17. Primiparous women with singleton pregnancy and spontaneous labor onset were randomized to continuous support ( = 30) or standard care ( = 29) during delivery. The primary outcome was the duration of active labor. Secondary outcomes were delivery mode, women's need of labor analgesia and satisfaction with delivery, maternal cortisol levels, and neonatal morbidity. Continuous support was followed by shorter active labor 11.0 ± 5.7 h compared to 13.7 ± 3.9 h with standard care ( = 0.001). Women in the continuous support group tended to have lower cortisol levels and low cortisol during the first ( = 0.02) and second ( = 0.04) stages of labor were correlated with shorter active labor. Continuous support was followed by spontaneous delivery in 73%, instrumental delivery in 24% and emergency cesarean section in 3% in contrast to standard care which was followed by spontaneous delivery in 62%, instrumental delivery in 24% and cesarean in 14% ( = 0.19). The continuous support group received combined analgesic methods more often ( = 0.04). Women's satisfaction with delivery and neonatal morbidity were comparable. Continuous labor support was followed by shorter active labor compared to standard care. Women with continuous support had a high rate of vaginal delivery and tended to have lower cortisol levels during all stages of active labor reflecting a lower stress level. Low cortisol was correlated to shorter active labor. Based on these results, we recommend continuous labor support for all primiparous women during active labor.
产科分娩大多被视为一个生理过程，而社会、文化、心理和超验方面受到的关注较少。有人提出分娩支持有助于促进分娩进程。本研究的目的是调查助产士持续的分娩支持是否能促进分娩进程和阴道分娩。这是一项于2015 - 2017年在瑞典一家大学医院进行的随机对照研究。单胎妊娠且自然发动分娩的初产妇在分娩期间被随机分为持续支持组（n = 30）或标准护理组（n = 29）。主要结局是活跃期分娩时长。次要结局包括分娩方式、产妇对分娩镇痛的需求及对分娩的满意度、产妇皮质醇水平和新生儿发病率。与标准护理组的13.7±3.9小时相比，持续支持组的活跃期分娩时长更短，为11.0±5.7小时（P = 0.001）。持续支持组的女性皮质醇水平往往较低，且在第一产程（P = 0.02）和第二产程（P = 0.04）皮质醇水平低与活跃期分娩时长较短相关。持续支持组中73%为自然分娩，24%为器械助产，3%为急诊剖宫产；相比之下，标准护理组中自然分娩为62%，器械助产为24%，剖宫产为14%（P = 0.19）。持续支持组更常采用联合镇痛方法（P = 0.04）。产妇对分娩的满意度和新生儿发病率相当。与标准护理相比，持续分娩支持使活跃期分娩时长更短。接受持续支持的女性阴道分娩率高，且在活跃期各阶段皮质醇水平往往较低，这反映出压力水平较低。皮质醇水平低与活跃期分娩时长较短相关。基于这些结果，我们建议在活跃期为所有初产妇提供持续的分娩支持。
