Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA.
University of Illinois Hospital, Chicago, Illinois, USA.
Birth. 2022 Dec;49(4):675-686. doi: 10.1111/birt.12633. Epub 2022 Apr 22.
Despite calls for increased vaginal birth after cesarean (VBAC), <14% of candidates have VBAC. Requirements for documentation of scar type, and prohibitions on induction or augmentation of labor are not supported by evidence but may be widespread. The purpose of this study was to document midwives' perceptions of barriers to labor after cesarean (LAC) and their effects on midwives' ability to accommodate patient desires for LAC.
Midwives certified by the American Midwifery Certification Board (AMCB) were surveyed in 2019. Multiple option and open-ended text responses were analyzed using quantitative statistics and thematic content analysis. Select barriers to LAC, ability to accommodate LAC, and supportiveness of collaborators among midwives offering LAC were explored.
Responses from 1398 midwives were analyzed. Eighty-four percent felt able to accommodate LAC "most of the time," and 39% reported one or more barriers to LAC. Barriers decreased ability to accommodate LAC by as much as 80%. Analysis of text responses revealed specific themes.
Thirty-nine percent of midwives reported their practice was limited by one or more barriers that were inconsistent with professional guidelines. Imposition of barriers was driven primarily by collaborating physicians, and superceded supportive practices of midwives, nurses, and system administrators. Affected midwives were significantly less able to accommodate patient requests for LAC than those not affected. Midwives also reported pride in providing VBAC care, restrictions specific to midwifery scope of practice, and variation in physician support for LAC within practices affecting their ability to provide care.
尽管人们呼吁增加剖宫产后阴道分娩（VBAC），但只有 <14%的候选人选择 VBAC。然而，关于记录疤痕类型的要求，以及禁止引产或催产，这些规定都没有得到证据的支持，但却广泛存在。本研究的目的是记录助产士对剖宫产后分娩（LAC）的障碍的看法，以及这些障碍对助产士满足患者 LAC 需求的能力的影响。
2019 年，对美国助产士认证委员会（AMCB）认证的助产士进行了调查。使用定量统计和主题内容分析对多项选择和开放式文本回复进行了分析。探讨了 LAC 提供助产士的 LAC 障碍、适应 LAC 的能力以及合作者的支持度。
对 1398 名助产士的回复进行了分析。84%的人表示“大多数时候”都能够适应 LAC，39%的人报告了 1 个或多个 LAC 障碍。障碍使适应 LAC 的能力降低了多达 80%。对文本回复的分析揭示了具体的主题。
39%的助产士报告说，他们的实践受到一个或多个与专业指南不一致的障碍限制。障碍的实施主要是由合作医生驱动的，并且超过了助产士、护士和系统管理员的支持性实践。受影响的助产士明显比不受影响的助产士更难以满足患者对 LAC 的需求。助产士还报告了为 VBAC 护理提供服务的自豪感、助产实践特有的限制以及医生对 LAC 的支持在实践中的差异，这些都影响了他们提供护理的能力。
