Engelhart Christina Hernandez, Nilsen Anne Britt Vika, Pay Aase Serine Devold, Maude Robyn, Kaasen Anne, Blix Ellen
Norwegian Research Centre for Women's Health, Oslo University Hospital, Norway; Faculty of Health Sciences, Oslo Metropolitan University, Norway.
Faculty of Health and Social Sciences, Western Norway University of Applied Science, Norway.
Midwifery. 2022 May;108:103288. doi: 10.1016/j.midw.2022.103288. Epub 2022 Feb 19.
In most high-income countries, the cardiotocography and handheld Doppler device have replaced the Pinard stethoscope for intrapartum foetal monitoring. As a result, the skills required to use the Pinard are rapidly disappearing from midwifery. The aim of this study was thus to illuminate the knowledge before it is lost, by exploring the practice, skills and experience of Norwegian midwives familiar with the Pinard for intrapartum foetal monitoring. We included midwives who still regularly use the Pinard in their current practice in a variety of birth settings, and those who used the Pinard in the era prior to the introduction of the CTG.
This study followed a qualitative descriptive design based on mainly focus group interviews, but also including one individual interview. The interviews explored the participants` perspective on their practice, skills and experience regarding the use of the Pinard for intrapartum foetal monitoring. Reflexive thematic analysis captured common patterns across the data, and contextualism was used as research paradigm.
In total, 21 midwives with experience using the Pinard for intrapartum foetal monitoring were interviewed. The midwives were either retired and had experience using the Pinard from before the CTG became widespread; worked in an alongside midwifery unit that only oversees low-risk births; or worked in an obstetric unit in a university hospital with an active policy of using the Pinard for intrapartum foetal monitoring.
The analysis resulted in four main themes: "Practice and experience with the Pinard are related to context", "Skills with the Pinard come with work experience", "The Pinard reveals certain characteristics of foetal sound" and "Midwives` experience with the benefits of using the Pinard". The midwives considered the context for using the Pinard for intrapartum foetal monitoring relevant. The e availability of technology and applicable situations for using the Pinard influenced how and when they use the Pinard. They further underpinned training and work experience as important for feeling secure when using the Pinard, and this experience made them recognize normal and abnormal foetal sounds. Defining and characterizing these sounds appeared difficult for the midwives, however, and they hesitated and imitated the sound. The midwives felt that the Pinard is beneficial for both the labouring woman and the midwife, as the Pinard's features bring them closer to the labouring woman and help calm the birth suite. They also felt that the Pinard adds further information about the birth and birth process, such as foetal lie, rotation and descent.
Norwegian midwives' practice, and experiences in using the Pinard for intrapartum foetal monitoring are connected to context as technological development and applicable situations. The midwives explained that knowledge obtained through experience gives them skills to differentiate between normal and abnormal foetal sound characteristics, though they found it difficult to define the characteristics themselves. Using the Pinard stethoscope during birth calms the birth suite and brings the midwife closer to the labouring woman.
在大多数高收入国家，产时胎儿监护已用胎心监护仪和手持式多普勒设备取代了皮纳德听诊器。因此，使用皮纳德听诊器所需的技能在助产行业正迅速消失。本研究的目的是通过探究熟悉使用皮纳德听诊器进行产时胎儿监护的挪威助产士的实践、技能和经验，在这些知识失传之前将其阐明。我们纳入了在各种分娩环境中仍在日常实践中经常使用皮纳德听诊器的助产士，以及在引入CTG（胎心监护仪）之前的时代使用过皮纳德听诊器的助产士。
本研究采用定性描述性设计，主要基于焦点小组访谈，但也包括一次个人访谈。访谈探讨了参与者对于使用皮纳德听诊器进行产时胎儿监护的实践、技能和经验的看法。反思性主题分析捕捉了数据中的共同模式，并将情境主义用作研究范式。
共有21名有使用皮纳德听诊器进行产时胎儿监护经验的助产士接受了访谈。这些助产士要么已退休，在CTG广泛应用之前就有使用皮纳德听诊器的经验；要么在仅负责低风险分娩的助产单位工作；要么在一家大学医院的产科工作，该医院有积极使用皮纳德听诊器进行产时胎儿监护的政策。
分析得出四个主要主题：“使用皮纳德听诊器的实践和经验与情境相关”、“使用皮纳德听诊器的技能来自工作经验”、“皮纳德听诊器能揭示胎儿声音的某些特征”以及“助产士对使用皮纳德听诊器的益处的体验”。助产士们认为使用皮纳德听诊器进行产时胎儿监护的情境是相关的。技术的可用性以及使用皮纳德听诊器的适用情况影响了他们使用皮纳德听诊器的方式和时间。他们进一步强调培训和工作经验对于使用皮纳德听诊器时感到安心很重要，并且这种经验使他们能够识别正常和异常的胎儿声音。然而，助产士们似乎难以定义和描述这些声音，他们会犹豫并模仿声音。助产士们认为皮纳德听诊器对产妇和助产士都有益，因为皮纳德听诊器的特性使他们更接近产妇，并有助于使分娩室氛围平静下来。他们还认为皮纳德听诊器能提供有关分娩和分娩过程的更多信息，例如胎儿的胎位、旋转和下降情况。
挪威助产士使用皮纳德听诊器进行产时胎儿监护的实践和经验与技术发展和适用情况等情境相关。助产士们解释说，通过经验获得的知识使他们有能力区分正常和异常的胎儿声音特征，尽管他们发现自己很难定义这些特征。在分娩时使用皮纳德听诊器能使分娩室氛围平静下来，并使助产士更接近产妇。
