Ulfsdottir H, Johnson K, Rubertsson C, Ekelin M, Edqvist M
Department of Women's Health and Health professions Karolinska University Hospital, Stockholm, Sweden.
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
Women Birth. 2023 Feb;36(1):e118-e124. doi: 10.1016/j.wombi.2022.05.003. Epub 2022 May 12.
Many high-income countries have seen an increase in severe perineal trauma. Teaching strategies and conditions for learning during the active second stage of labour are scarcely described.
To describe midwifery preceptors and midwifery students' experiences' of teaching and learning how to manage the second stage of labour, with the specific aim of preventing severe perineal trauma.
A qualitative study with focus group discussions and individual in depth-interviews with preceptor midwives (n = 23) and student midwives (n = 10). Data were analysed by qualitative content analysis.
"A complex and demanding situation with mutual need for feedback, reflection and safety" was the overall theme describing the conditions. Three sub-themes were identified. "Adapting to a unique situation" refers to the difficulty of teaching and learning the aspects needed to prevent severe perineal trauma, and to provide care during this stage. "Hindering and limiting circumstances" describes teaching strategies that were perceived negatively, and how midwifery students tried to adapt to the preceptors rather than the birthing women. "A trustful and communicative relationship" describes the importance of the relationship between the student and the preceptor, where communication was a central, but not obvious part.
An increased awareness among preceptors is needed to optimize teaching strategies, enabling the students to focus on learning the art of the second stage of labour; supporting the woman, preventing severe perineal trauma and ensuring the safety of the unborn baby. Future research should address how existing prevention models can include training to increase preceptors' confidence in teaching.
许多高收入国家严重会阴创伤的发生率有所上升。关于分娩活跃期第二产程教学策略及学习条件的描述甚少。
描述助产指导教师和助产专业学生在学习和教授如何管理第二产程方面的经验，特别旨在预防严重会阴创伤。
采用定性研究方法，通过焦点小组讨论以及对助产指导教师（n = 23）和助产专业学生（n = 10）进行个人深度访谈收集数据。采用定性内容分析法对数据进行分析。
“一种对反馈、反思和安全有共同需求的复杂且要求较高的情况”是描述这些条件的总体主题。确定了三个子主题。“适应独特情况”指的是教授和学习预防严重会阴创伤所需的方面以及在此阶段提供护理的难度。“阻碍和限制因素”描述了被认为具有负面影响的教学策略，以及助产专业学生如何试图去适应指导教师而非产妇。“信任和沟通的关系”描述了学生与指导教师之间关系的重要性，其中沟通是核心但并非明显的部分。
需要提高指导教师的意识，以优化教学策略，使学生能够专注于学习第二产程的技巧；支持产妇、预防严重会阴创伤并确保未出生婴儿的安全。未来的研究应探讨现有的预防模式如何能够纳入培训，以增强指导教师的教学信心。
