分娩活跃期一对一助产护理与分娩镇痛和分娩结局的关系：一项初产妇队列研究。

Association between one-to-one midwifery care in the active phase of labour and use of pain relief and birth outcomes: A cohort of nulliparous women.

机构信息

Department of Obstetrics and Gynaecology, Østfold Hospital Trust, PO box 300, Grålum 1714, Norway.

Department of Obstetrics and Gynaecology, Østfold Hospital Trust, PO box 300, Grålum 1714, Norway; Department of Health Promotion, Faculty of Health Sciences, Oslomet - Oslo Metropolitan University, Oslo, Norway.

出版信息

Midwifery. 2022 Jul;110:103341. doi: 10.1016/j.midw.2022.103341. Epub 2022 Apr 18.

DOI:10.1016/j.midw.2022.103341

PMID:35486962

Abstract

OBJECTIVE

To investigate the association between one-to-one midwifery care and birth outcomes with pain relief as the primary outcome. Secondary outcomes include obstetric and neonatal outcomes, such as mode of birth and Apgar score.

DESIGN

A cohort study of women originally included in a cluster randomised trial.

SETTING AND PARTICIPANTS

The analysis is based on data from The Labour Progression Study (LaPS), a cluster randomised controlled trial (RCT) including 7,277 women, conducted in fourteen obstetric units in Norway, between 2014 and 2017. The participants were nulliparous with a singleton full-term foetus in a cephalic presentation and spontaneous onset of labour. In this cohort, 7,103 women with information about on one-to-one midwifery care were included.

MEASUREMENTS AND FINDINGS

Logistic regression analysis show that nulliparous women receiving one-to-one midwifery care in the active phase of labour are less likely to have an epidural analgesia, adjusted OR of 0.81 (95% CI 0.72,0.91), less likely to be given nitrous oxide, adjusted OR of 0.77 (95% CI 0.69,0.85), and they more often received massages, adjusted OR of 1.76 (95% CI 1.47,2.11), compared with women not receiving one-to-one midwifery care. Descriptive analyses show that women receiving one-to-one midwifery care in the active phase of labour are less likely to have a caesarean section (5.8% vs. 7.2%) and they are less likely to have an operative vaginal birth (16.5% vs. 23.7%). No significant differences were observed between the groups in terms of low Apgar scores at five minutes.

KEY CONCLUSIONS

We found that one-to-one midwifery care in the active phase of labour may be associated with birth outcomes, including decreased use of epidural analgesia and a decreased rate of caesarean sections and operative vaginal birth.

IMPLICATIONS FOR PRACTICE

The results of this study could encourage midwives to be present during the active phase of labour to promote physiological birth.

摘要

目的

以缓解疼痛为主要结局，探讨一对一助产护理与分娩结局的关系。次要结局包括分娩方式和阿普加评分等产科和新生儿结局。

设计

对最初纳入一项整群随机试验的女性进行队列研究。

地点和参与者

该分析基于挪威 14 个产科单位于 2014 年至 2017 年期间开展的一项整群随机对照试验（LaPS）的数据，该试验纳入了 7277 名初产妇，单胎足月头位且自发临产。在此队列中，纳入了 7103 名有一对一助产护理信息的女性。

测量和发现

逻辑回归分析显示，分娩活跃期接受一对一助产护理的初产妇使用硬膜外镇痛的可能性较小，调整后的比值比（OR）为 0.81（95%CI，0.72~~0.91），使用笑气的可能性较小，调整后的 OR 为 0.77（95%CI，0.69~~0.85），更常接受按摩，调整后的 OR 为 1.76（95%CI，1.47~2.11），与未接受一对一助产护理的女性相比。描述性分析显示，分娩活跃期接受一对一助产护理的女性剖宫产率较低（5.8% vs. 7.2%），阴道助产分娩率也较低（16.5% vs. 23.7%）。两组在 5 分钟时低阿普加评分方面无显著差异。