VIVES University of Applied Sciences, Doorniksesteenweg 145, 8500, Kortrijk, Belgium.
Student master management and policy of health care, department of Public Health and Nursing and Midwifery Unit, Vrije Universiteit Brussel, UZ Brussel, Brussels, Belgium.
BMC Pregnancy Childbirth. 2022 Jul 8;22(1):551. doi: 10.1186/s12884-022-04890-x.
Health care providers have an important role to share evidence based information and empower patients to make informed choices. Previous studies indicate that shared decision making in pregnancy and childbirth may have an important impact on a woman's birth experience. In Flemish social media, a large number of women expressed their concern about their birth experience, where they felt loss of control and limited possibilities to make their own choices. The aim of this study is to explore autonomy and shared decision making in the Flemish population.
This is a cross-sectional, non-interventional study to explore the birth experience of Flemish women. A self-assembled questionnaire was used to collect data, including the Pregnancy and Childbirth Questionnaire (PCQ), the Labor Agentry Scale (LAS), the Mothers Autonomy Decision Making Scale (MADM), the 9-item Shared Decision Making Questionnaire (SDM-Q9) and four questions on preparation for childbirth. Women who gave birth two to 12 months ago were recruited by means of social media in the Flemish area (Northern part of Belgium). Linear mixed-effect modelling with backwards variable selection was applied to examine relations with autonomy in decision making.
In total, 1029 mothers participated in this study of which 617 filled out the survey completely. In general, mothers experienced moderate autonomy in decision-making, both with an obstetrician and with a midwife with an average on the MADM score of respectively 18.5 (± 7.2) and 29.4 (±10.4) out of 42. The linear mixed-effects model showed a relationship between autonomy in decision-making (MADM) for the type of healthcare provider (p < 0.001), the level of self-control during labour and birth (LAS) (p = 0.003), the level of perceived quality of care (PCQ) (p < 0.001), having epidural analgesia during childbirth (p = 0.026) and feeling to have received sufficient information about the normal course of childbirth (p < 0.001).
Childbearing women in Flanders experience moderate levels of autonomy in decision- making with their health care providers, where lower autonomy was observed for obstetricians compared to midwives. Future research should focus more on why differences occur between obstetrics and midwives in terms of autonomy and shared decision-making as perceived by the mother.
医疗保健提供者在分享循证信息和赋予患者知情决策方面发挥着重要作用。先前的研究表明，妊娠和分娩中的共同决策可能对女性的分娩体验产生重要影响。在佛兰芒社交媒体上，大量女性对自己的分娩经历表示担忧，她们感到失去控制，选择的可能性有限。本研究旨在探索佛兰芒人群中的自主性和共同决策。
这是一项横断面、非干预性研究，旨在探讨佛兰芒女性的分娩体验。使用自行组装的问卷收集数据，包括妊娠和分娩问卷（PCQ）、分娩代理量表（LAS）、母亲自主决策量表（MADM）、9 项共享决策问卷（SDM-Q9）和四个关于分娩准备的问题。通过佛兰芒地区（比利时北部）的社交媒体招募分娩后 2 至 12 个月的女性。应用向后变量选择的线性混合效应模型来检验与决策自主性的关系。
共有 1029 名母亲参与了这项研究，其中 617 名母亲完整填写了调查。总体而言，母亲在与产科医生和助产士决策时具有中等程度的自主性，MADM 平均得分为 18.5（±7.2）和 29.4（±10.4）。线性混合效应模型显示，决策自主性（MADM）与医疗保健提供者类型（p<0.001）、分娩时自我控制水平（LAS）（p=0.003）、感知护理质量水平（PCQ）（p<0.001）、分娩时使用硬膜外镇痛（p=0.026）和感觉已收到足够的关于正常分娩过程的信息（p<0.001）之间存在关系。
佛兰德斯的产妇在与医疗保健提供者共同决策时经历了中等程度的自主性，与助产士相比，她们对产科医生的自主性较低。未来的研究应更多地关注为什么母亲感知到产科医生和助产士在自主性和共同决策方面存在差异。
