Division of Obstetric Specialties and Midwifery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States.
Yale School of Nursing, Orange, Connecticut, United States.
J Midwifery Womens Health. 2022 Sep;67(5):552-560. doi: 10.1111/jmwh.13382. Epub 2022 Jun 26.
Effective collaboration between midwives and obstetricians on labor and birth units in hospitals has been shown to improve birth outcomes and quality of care. Guidelines for collaborative care in the United States exist; however, studies describing the actual lived experiences of midwives and obstetricians in collaborative practice are lacking. The goal of this study was to explore the experiences and perspectives of midwives and obstetricians working in collaborative practices on labor and birth units across the United States and to identify strategies that foster effective collaboration between them.
We performed qualitative analyses of open-ended comments obtained in an instrument validation survey assessing collaboration between midwives and obstetricians on labor and birth in the United States. Certified nurse-midwives, certified midwives, attending general obstetricians, maternal-fetal medicine attending physicians, and fellows across the United States were included in this study, herein called midwives and obstetricians. The final sample in the original validation survey included 232 midwives and 471 obstetricians (n = 703). Of these, 79 midwives and 132 obstetricians (n = 211) provided narrative comments on their perspectives and experiences with collaborative practice on labor and birth units in the United States. The narrative comments were analyzed using inductive techniques derived from grounded theory.
Four themes around how to foster effective collaboration were identified: (1) developing trust and respect, (2) promoting effective communication, (3) individual variability and need for clear guidelines, and (4) balancing autonomy. The midwives and obstetricians shared lived experiences that they perceived affected their work satisfaction and clinical outcomes in collaborative practices.
These findings hold potential to inform clinicians and health care leaders on ways to foster effective collaboration between midwives and obstetricians on labor and birth units. This in turn can improve quality of care for birthing persons, perinatal outcomes and clinician job satisfaction.
医院分娩和产房单元中助产士和产科医生之间的有效协作已被证明可以改善分娩结果和护理质量。美国存在关于协作护理的指南；然而，缺乏描述助产士和产科医生在协作实践中实际生活体验的研究。本研究的目的是探索美国协作实践中的助产士和产科医生在分娩和产房单元中的经验和观点，并确定促进他们之间有效协作的策略。
我们对在美国评估助产士和产科医生之间协作的工具验证调查中获得的开放式评论进行了定性分析。本研究包括美国的认证护士助产士、认证助产士、主治产科医生、母胎医学主治医生和研究员。原始验证调查的最终样本包括 232 名助产士和 471 名产科医生（n = 703）。其中，79 名助产士和 132 名产科医生（n = 211）就他们在美国分娩和产房单元的协作实践观点和经验提供了叙述性评论。使用源自扎根理论的归纳技术对叙述性评论进行了分析。
确定了四个促进有效协作的主题：（1）建立信任和尊重，（2）促进有效沟通，（3）个体差异和对明确指导方针的需求，以及（4）平衡自主权。助产士和产科医生分享了他们认为影响其在协作实践中工作满意度和临床结果的生活体验。
这些发现有可能为临床医生和医疗保健领导者提供有关在分娩和产房单元中促进助产士和产科医生之间有效协作的信息。这反过来又可以改善分娩者的护理质量、围产期结局和临床医生的工作满意度。
