James Cook University, Townsville, Queensland, Australia.
Wollongong Hospital, Wollongong, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2022 Feb;62(1):40-46. doi: 10.1111/ajo.13462. Epub 2021 Nov 28.
Prioritising normal birth has led to harm in some instances in the United Kingdom. While Australian organisations also promote normal birth, its negative impact is less well understood here.
This study explores the problems that may arise from the promotion of normal birth and the quality of clinical incident investigations.
This study uses a survey-based research design and has received 1278 responses. The main outcome measures include perceptions on bias against interventions, delays in interventions, systemic attempts to reduce caesarean rates, and clinical incident investigations.
The perception among both obstetric and midwifery cohorts is that the promotion of normal birth may sometimes or frequently lead to bias against intervention for women (93.8% vs 63.2%), bias against intervention for clinicians (81.1% vs 53.1%), delays in interventions (86.8% vs 37.4%), maternal request caesarean sections being discouraged (81.2% vs 66.9%), an increased emphasis on vaginal birth after caesarean (88.1% vs 69.3%), and a culture of vaginal births 'at all costs' leading to poor outcomes for mothers and babies (79.5% vs 24.7%). Respondents believe clinical incident investigations to be 'frequently' independent (48% vs 48.2%) but engagement of women in these processes is often missing or 'rarely' seen (46.6% vs 51.7%).
This study finds that Australian maternity healthcare providers believe institutional encouragement of normal birth has created work practices in maternity care that compromise patient safety and reduce the agency of the woman in the choices she makes. Current regulatory standards must change to reflect core ethical and legal obligations around informed consent.
在英国，优先选择自然分娩在某些情况下导致了伤害。尽管澳大利亚的组织也提倡自然分娩，但它在这里的负面影响却鲜为人知。
本研究探讨了促进自然分娩和临床事件调查质量可能出现的问题。
本研究采用基于调查的研究设计，共收到 1278 份回复。主要的结果测量指标包括对干预措施的偏见、干预措施的延迟、系统降低剖宫产率的尝试以及临床事件调查的看法。
在产科和助产士两个群体中，人们普遍认为，促进自然分娩有时或经常会导致对妇女干预措施的偏见（93.8%比 63.2%）、对临床医生干预措施的偏见（81.1%比 53.1%）、干预措施的延迟（86.8%比 37.4%）、劝阻产妇要求行剖宫产（81.2%比 66.9%）、增加对剖宫产后阴道分娩的重视（88.1%比 69.3%）以及为了母亲和婴儿的利益不惜一切代价追求阴道分娩的文化，导致母亲和婴儿的结局较差（79.5%比 24.7%）。受访者认为临床事件调查“经常”是独立的（48%比 48.2%），但妇女参与这些过程的情况往往缺失或“很少”（46.6%比 51.7%）。
本研究发现，澳大利亚的产妇保健提供者认为机构对自然分娩的鼓励，在产妇保健工作中创造了危及患者安全并减少妇女在其选择中自主权的实践。当前的监管标准必须改变，以反映知情同意的核心伦理和法律义务。
