Vogels-Broeke Maaike, Cellissen Evelien, Daemers Darie, Budé Luc, de Vries Raymond, Nieuwenhuijze Marianne
Research Centre for Midwifery Science, Zuyd University, Maastricht, The Netherlands.
Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Birth. 2023 Jun;50(2):384-395. doi: 10.1111/birt.12674. Epub 2022 Aug 17.
A positive childbirth experience is an important outcome of maternity care. A significant component of a positive birth experience is the ability to exercise autonomy in decision-making. In this study, we explore women's reports of their autonomy during conversations about their care with maternity care practitioners during pregnancy and childbirth.
Data were obtained from a cross-sectional survey of women living in The Netherlands that asked about their experiences during pregnancy and childbirth, including their role in conversations concerning decisions about their care.
A total of 3494 women were included in this study. Most women scored high on autonomy in decision-making conversations. During the latter stage of pregnancy (32+ weeks) and in childbirth, women reported significantly lower levels of autonomy in their care conversations with obstetricians as compared with midwives. Linear regression analyses showed that women's perception of personal treatment increased women's reported autonomy in their conversations with both midwives and obstetricians. Almost half (49.1%) of the women who had at least one intervention during birth reported pressure to accept or submit to that intervention. This was indicated by 48.3% of women with induced labor, 47.3% who had an instrumental vaginal birth, 45.2% whose labor was augmented, and 41.9% of women who had a cesarean birth.
In general, women's sense of autonomy in decision-making conversations during prenatal care and birth is high, but there is room for improvement, and this appeared most notably in conversations with obstetricians. Women's sense of autonomy can be enhanced with personal treatment, including shared decision-making and the avoidance of pressuring women to accept interventions.
积极的分娩体验是产科护理的一项重要成果。积极分娩体验的一个重要组成部分是在决策过程中行使自主权的能力。在本研究中，我们探讨了女性在孕期和分娩期间与产科护理从业者讨论护理问题时对自身自主权的报告。
数据来自对荷兰女性的一项横断面调查，该调查询问了她们在孕期和分娩期间的经历，包括她们在有关护理决策的讨论中所扮演的角色。
本研究共纳入3494名女性。大多数女性在决策对话中的自主权得分较高。在妊娠后期（32周及以上）和分娩期间，与助产士相比，女性报告称与产科医生讨论护理问题时的自主权水平显著较低。线性回归分析表明，女性对个性化治疗的感知提高了她们在与助产士和产科医生对话中报告的自主权。在分娩期间至少接受过一次干预的女性中，近一半（49.1%）表示有接受或服从该干预的压力。引产女性中有48.3%、器械助产阴道分娩女性中有47.3%、产程增强女性中有45.2%以及剖宫产女性中有41.9%表示存在这种情况。
总体而言，女性在产前护理和分娩期间决策对话中的自主意识较高，但仍有改进空间，这在与产科医生的对话中最为明显。通过个性化治疗，包括共同决策和避免向女性施压接受干预，可以增强女性的自主意识。
