Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran.
BMC Pregnancy Childbirth. 2023 Oct 31;23(1):765. doi: 10.1186/s12884-023-05987-7.
The aim of this study was to compare maternal and neonatal outcomes in the care provided by Doula, trained lay companion, and routine midwifery care in the labor and obstetric units. In this study, only results related to maternal outcomes were presented.
This is a quasi-experimental study, which was conducted on 150 women with low-risk pregnancies who had been selected for vaginal birth at private clinics and public hospitals of Arak, Iran. Participants were divided into three groups, two intervention groups, doula and trained lay companion, and one control group, midwife's routine care. The intervention groups, in addition to receiving routine care from the labor and maternity units, also received support and training by doula or a trained lay companion, but 50 the control group received only routine midwifery care. In the control group and the trained companion, the samples were taken from 10 clinics of different parts of the city by random sampling method using the SIB center system. Then, among selected numbers, we randomly selected samples for each group. But in Doula group, because of limited number of samples, convenience sampling was used and all women enrolled in doula care were included in the study until the number reached 50. In each group, outcomes such as the duration of active phase and second stage of labor, as well as the severity of pain, anxiety and maternal satisfaction with birth were measured and compared with other groups. Data were collected by a researcher-made checklist, the Spielberger's State-Trait Anxiety Inventory (STAI), the Pain Visual Assessment Scale (VAS), and the Hollins Martin's Birth Satisfaction Scale-Revised (BSS-R). Data were analyzed by SPSS-22 statistical software using Kruskal Wallis, Chi-Square, ANOVA and Fisher's exact tests.
Based on the results, the mean duration of active phase between three groups was 234.68 ± 118.74, 256.66 ± 108.75 and 279 ± 94.37 min, respectively (p = 0.022). Also, the mean duration of second stage in three groups was 10 ± 5.61, 10.35 ± 5.1 and 22.30 ± 75.57 min, respectively (p < 0.001). The difference between mean pain scores in the first, second, third, fourth and fifth hours was not statistically significant. The average difference in anxiety score in the two stages of labor was higher in the lay companion group, and this difference was statistically significant (p < 0.001); however, the level of satisfaction in doula group was higher compared to the lay companion and control groups (p < 0.00 1).
According to present study, doula care has a greater effect on reducing the duration of labor than other care models. Based on the study, there was no statistically significant difference between the three groups in terms of variables such as the severity of labor pain. However, the level of anxiety of pregnant mothers in the group supported by lay companion was lower than the other two groups, which indicates the positive effect of mothers' training on increasing maternal comfort and satisfaction. It is suggested that further research investigate the severity of labor pain in groups supported by different care models and also we recommend the use of lay companion' support during childbearing of mothers who could not afford doula.
This article has been registered in Iran's Clinical Trial Center with the code: IRCT20230620058548N1. 2023/08/29.
本研究旨在比较导乐、经过培训的陪产员和常规助产士在分娩和产科单位提供的护理中母婴结局。在本研究中，仅呈现了与母婴结局相关的结果。
这是一项准实验研究，在伊朗阿拉克的私人诊所和公立医院选择阴道分娩的 150 名低风险孕妇中进行。参与者被分为三组，两组干预组，导乐和经过培训的陪产员，一组对照组，常规助产士护理。干预组除了接受分娩和产科单位的常规护理外，还接受了导乐或经过培训的陪产员的支持和培训，但对照组仅接受常规助产士护理。在对照组和经过培训的陪产员中，通过 SIB 中心系统随机抽样法从城市不同地区的 10 个诊所抽取样本。然后，在所选择的数字中，我们为每组随机抽取样本。但在导乐组中，由于样本数量有限，采用方便抽样法，将所有参加导乐护理的妇女纳入研究，直到达到 50 名。在每组中，测量并比较活跃期和第二产程的持续时间、疼痛严重程度、焦虑程度以及母亲对分娩的满意度等结果。数据通过研究者自制检查表、斯皮尔伯格状态特质焦虑量表（STAI）、疼痛视觉评估量表（VAS）和霍林斯·马丁分娩满意度量表修订版（BSS-R）收集。使用 Kruskal Wallis、卡方、方差分析和 Fisher 确切检验等 SPSS-22 统计软件对数据进行分析。
根据结果，三组之间活跃期的平均持续时间分别为 234.68±118.74、256.66±108.75 和 279±94.37 分钟（p=0.022）。此外，三组之间第二产程的平均持续时间分别为 10±5.61、10.35±5.1 和 22.30±75.57 分钟（p<0.001）。第一、二、三、四和第五小时的平均疼痛评分之间没有统计学显著差异。在两个产程中，陪产员组的焦虑评分平均差异较高，且具有统计学意义（p<0.001）；然而，导乐组的满意度水平高于陪产员组和对照组（p<0.001）。
根据本研究，导乐护理对缩短产程的效果优于其他护理模式。基于本研究，三组在产程疼痛严重程度等变量方面没有统计学显著差异。然而，陪产员组孕妇的焦虑水平低于其他两组，这表明母亲培训对增加产妇舒适度和满意度具有积极影响。建议进一步研究不同护理模式支持的组别的产程疼痛严重程度，并且我们建议在母亲无法承担导乐费用时使用陪产员的支持。
本文已在伊朗临床试验中心注册，注册号为：IRCT20230620058548N1。2023 年 8 月 29 日。
