Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden.
Department of Obstetrics and Gynecology, Skane University Hospital, Lund, Sweden.
PLoS One. 2024 Jun 12;19(6):e0304418. doi: 10.1371/journal.pone.0304418. eCollection 2024.
To study informed consent to midwifery practices and interventions during the second stage of labor and to investigate the association between informed consent and experiences of these practices and interventions and women's experiences of the second stage of labor.
This study uses an observational design with data from a follow-up questionnaire sent to women one month after giving birth spontaneously in the Oneplus trial, a study aimed at evaluating collegial midwifery assistance to reduce severe perineal trauma. The trial was conducted between 2018-2020 at five Swedish maternity wards and trial registered at clinicaltrials.gov, no NCT03770962. The follow-up questionnaire contained questions about experiences of the second stage of labor, practices and interventions used and whether the women had provided informed consent. Evaluated practices and interventions were the use of warm compresses held at the perineum, manual perineal protection, vaginal examinations, perineal massage, levator pressure, intermittent catheterization of the bladder, fundal pressure, and episiotomy. Associations between informed consent and women's experiences were assessed by univariate and multivariable logistic regression.
Of the 3049 women participating in the trial, 2849 consented to receive the questionnaire. Informed consent was reported by less than one in five women and was associated with feelings of being safe, strong, and in control. Informed consent was further associated with more positive experiences of clinical practices and interventions, and with less discomfort and pain from interventions involving physical penetration of the genital area.
The findings indicate that informed consent during the second stage is associated with feelings of safety and of being in control. With less than one in five women reporting informed consent to all practices and interventions performed by midwives, the results emphasize the need for further action to enhance midwives' knowledge and motivation in obtaining informed consent prior to performance of interventions.
研究产妇第二产程中助产实践和干预措施的知情同意情况，并调查知情同意与这些实践和干预措施以及女性对第二产程体验之间的关系。
本研究采用观察性设计，数据来自 Oneplus 试验的产后一个月随访问卷，该试验旨在评估助产士协作以减少严重会阴创伤。该试验于 2018-2020 年在瑞典的五家产科病房进行，在 clinicaltrials.gov 上注册，编号为 NCT03770962。随访问卷包含有关第二产程体验、使用的实践和干预措施以及女性是否提供知情同意的问题。评估的实践和干预措施包括会阴热敷、会阴保护、阴道检查、会阴按摩、肛提肌施压、间歇性导尿、宫底按压和会阴切开术。通过单变量和多变量逻辑回归评估知情同意与女性体验之间的关系。
在参与试验的 3049 名女性中，有 2849 名女性同意接受问卷。不到五分之一的女性报告知情同意，与感到安全、强壮和控制感有关。知情同意与对临床实践和干预措施的更积极体验相关，与涉及生殖器区域物理穿透的干预措施引起的不适和疼痛减少相关。
研究结果表明，第二产程中的知情同意与安全感和控制感有关。只有不到五分之一的女性报告对助产士实施的所有实践和干预措施知情同意，这一结果强调需要进一步采取行动，增强助产士在实施干预措施前获得知情同意的知识和动力。
