Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, USA.
Division of Data Analytics, Planning and Monitoring, United Nations Children's Fund, New York, NY, USA.
Reprod Health. 2023 Jan 6;20(1):7. doi: 10.1186/s12978-022-01546-z.
Although several indicators have been proposed to measure women's experience of care in health facilities during the intrapartum period, it is unknown if these indicators perform differently in the context of obstetric emergencies. We examined the relationship between experience of care indicators from the Person-Centered Maternity Care (PCMC) scale and obstetric complications.
We used data from four cross-sectional surveys conducted in Kenya (rural: N = 873; urban: N = 531), Ghana (N = 531), and India (N = 2018) between August 2016 and October 2017. The pooled sample included 3953 women aged 15-49 years who gave birth within 9 weeks prior to the survey. Experience of care was measured using the PCMC scale. Univariate, bivariate, and multivariable analyses were conducted to examine the associations between the composite and 31 individual PCMC indicators with (1) obstetric complications; (2) severity of complications; and (3) delivery by cesarean section (c-section).
16% (632) of women in the pooled sample reported obstetric complications; and 4% (132) reported having given birth via c-Sect. (10.5% among those with complications). The average standardized PCMC scores (range 0-100) were 63.5 (SD = 14.1) for the full scale, 43.2 (SD = 20.6) for communication and autonomy, 67.8 (SD = 14.1) for supportive care, and 80.1 (SD = 18.2) for dignity and respect sub-scales. Women with complications had higher communication and autonomy scores (45.6 [SD = 20.2]) on average compared to those without complications (42.7 [SD = 20.6]) (p < 0.001), but lower supportive care scores, and about the same scores for dignity and respect and for the overall PCMC. 18 out of 31 experience of care indicators showed statistically significant differences by complications, but the magnitudes of the differences were generally small, and the direction of the associations were inconsistent. In general, women who delivered by c-section reported better experiences.
There is insufficient evidence based on our analysis to suggest that women with obstetric complications report consistently better or worse experiences of care than women without. Women with complications appear to experience better care on some indicators and worse care on others. More studies are needed to understand the relationship between obstetric complications and women's experience of care and to explore why women who deliver by c-section may report better experience of care.
尽管已经提出了一些指标来衡量产妇在分娩期间在医疗机构中的护理体验，但尚不清楚这些指标在产科急症的情况下表现是否不同。我们研究了产妇以人为本人文关怀（PCMC）量表的护理体验指标与产科并发症之间的关系。
我们使用了 2016 年 8 月至 2017 年 10 月期间在肯尼亚（农村：N=873；城市：N=531）、加纳（N=531）和印度（N=2018）进行的四项横断面调查的数据。汇总样本包括在调查前 9 周内分娩的 3953 名 15-49 岁的妇女。使用 PCMC 量表测量护理体验。进行了单变量、双变量和多变量分析，以检查复合和 31 个个体 PCMC 指标与（1）产科并发症；（2）并发症严重程度；和（3）剖腹产（c 段）之间的关联。
汇总样本中 16%（632）的妇女报告有产科并发症；4%（132）报告行剖宫产术。（并发症组中为 10.5%）。完整量表的平均标准化 PCMC 得分为 63.5（SD=14.1），沟通和自主权得分为 43.2（SD=20.6），支持性护理得分为 67.8（SD=14.1），尊严和尊重得分为 80.1（SD=18.2）。与无并发症的妇女相比，有并发症的妇女的沟通和自主权得分平均较高（45.6 [SD=20.2]）（p<0.001），但支持性护理得分较低，尊严和尊重以及整体 PCMC 得分大致相同。31 项护理体验指标中有 18 项因并发症而存在统计学差异，但差异幅度通常较小，且关联方向不一致。一般来说，行剖宫产的妇女报告的体验较好。
根据我们的分析，没有足够的证据表明有产科并发症的妇女的护理体验始终好于或差于无并发症的妇女。有并发症的妇女在某些指标上的护理体验较好，而在其他指标上的护理体验较差。需要进一步的研究来了解产科并发症与妇女护理体验之间的关系，并探讨为什么行剖宫产的妇女可能会报告更好的护理体验。
