Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
NHS Highland, Assynt House, Beechwood Park, Inverness, IV2 3BW, UK.
Patient. 2023 Mar;16(2):117-125. doi: 10.1007/s40271-022-00608-5. Epub 2022 Nov 9.
The views of mothers are important in shaping policy and practice regarding options for intrapartum care. Mothers in rural and remote areas face unique challenges accessing services, and these need to be well understood. Therefore, our aim was to understand the compromises that women who live in remote and rural settings, more than 1 h from a maternity unit, face regarding intrapartum care.
Qualitative semi-structured telephone interviews (n = 14) were undertaken in rural Scotland with 13 women who had young children and one who was pregnant. Interviews were transcribed and thematically analysed by two researchers.
Key themes identified were women's perceptions about risk and the safety of different pathways of maternity care and birth locations; the actual and perceived distance between home and the place of birth, and the type of maternity care available at a place of birth. Mothers in rural and remote areas face particular challenges in choosing where to have their babies. In addition to clinical decisions about 'place of birth' agreed with healthcare professionals, they have to mentally juggle the implications of giving birth when at a distance from family support and away from familiar surroundings. It was clear that many women from rural communities have a strong sense of 'place' and that giving birth in a geographical location, community and culture that feels familiar is important to many of them.
Health care staff need to appreciate the impact of non-clinical factors that are important to mothers in remote and rural areas and acknowledge these, even when they cannot be accommodated. Local and national policy also needs to reflect and respond to the practical challenges faced by rurality.
母亲的观点对于形成产时护理选择的政策和实践非常重要。农村和偏远地区的母亲在获得服务方面面临着独特的挑战，这些挑战需要得到充分理解。因此，我们的目的是了解居住在偏远和农村地区（距离产科单位超过 1 小时）的女性在产时护理方面面临的妥协。
在苏格兰农村地区，对 13 名有年幼子女的女性和 1 名孕妇进行了定性半结构式电话访谈（n=14）。访谈由两名研究人员进行转录和主题分析。
确定的主要主题是女性对不同产时护理途径和分娩地点的风险和安全性的看法；家庭和分娩地点之间的实际和感知距离，以及分娩地点可获得的母婴保健类型。农村和偏远地区的母亲在选择分娩地点方面面临着特殊的挑战。除了与医疗保健专业人员就“分娩地点”达成的临床决策外，她们还必须在远离家庭支持和熟悉环境的情况下分娩时，心理上权衡分娩的影响。很明显，许多来自农村社区的女性对“地方”有着强烈的认同感，对许多女性来说，在一个感觉熟悉的地理位置、社区和文化中分娩是很重要的。
医疗保健人员需要了解对偏远和农村地区母亲来说重要的非临床因素的影响，并承认这些因素，即使无法满足这些因素。地方和国家政策也需要反映和应对农村地区面临的实际挑战。
