以人为主的围产期保健与孕期、分娩期及产后的赋权：一项横断面混合方法分析
Person-Centered Perinatal Health Care and Empowerment During Pregnancy, Birth, and Postpartum: A Cross-Sectional Mixed-Methods Analysis.
作者信息
Woofter Rebecca, Clarke Renee, Diala Prisca C, Altman Molly R, Afulani Patience A
机构信息
Department of Community Health Sciences, University of California Los Angeles, Los Angeles, California.
Department of Maternal and Child Health, University of California Berkeley, Berkeley, California.
出版信息
J Midwifery Womens Health. 2025 May-Jun;70(3):476-485. doi: 10.1111/jmwh.13760. Epub 2025 May 19.
INTRODUCTION
In the United States, Black birthing people report poor-quality health care and face adverse maternal and infant outcomes. Empowerment to advocate with health care providers could help improve outcomes for birthing people of color. The literature is, however, sparse on factors associated with empowerment in the perinatal period. We examined the association between person-centered care and feeling empowered to advocate with health care providers across the perinatal period.
METHODS
Data are from 265 postpartum birthing persons who completed an online survey in 2020. The survey included validated scales for Person-Centered Prenatal Care (PCPC) and Person-Centered Maternity (labor and birth) Care (PCMC), feelings of empowerment to advocate with health care providers, and an open-response question regarding empowerment. Multivariable logistic regression models and qualitative thematic analysis were conducted.
RESULTS
A majority of the sample was Black, married, had one child, had college degrees, had private insurance, and gave birth in a hospital with midwives. Overall, about 75% of the sample felt empowered to advocate with health care providers during prenatal care, birth, and postpartum. On average, participants scored 84 of 100 on the standardized PCPC scale and 90 of 100 on the standardized PCMC scale. Each one-point increase in PCPC score was associated with 11% higher odds of feeling empowered during prenatal care. Each one-point increase in PCMC score was associated with 8% higher odds of feeling empowered during both birth and postpartum. Respect and dignity drove the association between PCPC and empowerment during prenatal care, whereas communication and autonomy drove the association between PCMC and empowerment. Qualitative responses emphasized the importance of communication and respect from health care providers, autonomy, and social support from partners and doulas on empowerment.
DISCUSSION
Person-centered perinatal health care is associated with feeling empowered to advocate with health care providers during prenatal care, birth, and postpartum. Effective communication and autonomy are vital for fostering patient empowerment.
引言
在美国，黑人分娩者报告称医疗保健质量不佳，并且面临不良的母婴结局。增强与医疗保健提供者进行沟通的能力有助于改善有色人种分娩者的结局。然而，关于围产期与增强能力相关因素的文献却很少。我们研究了以患者为中心的护理与整个围产期增强与医疗保健提供者沟通能力之间的关联。
方法
数据来自265名在2020年完成在线调查的产后分娩者。该调查包括经过验证的以患者为中心的产前护理（PCPC）和以患者为中心的孕产（分娩）护理（PCMC）量表、与医疗保健提供者沟通的能力感受，以及一个关于增强能力的开放性问题。进行了多变量逻辑回归模型和定性主题分析。
结果
大多数样本为黑人，已婚，育有一个孩子，拥有大学学位，有私人保险，并且在有助产士的医院分娩。总体而言，约75%的样本在产前护理、分娩和产后期间感到有能力与医疗保健提供者沟通。平均而言，参与者在标准化PCPC量表上的得分为84分（满分100分），在标准化PCMC量表上的得分为90分（满分100分）。PCPC得分每增加一分，在产前护理期间感到有能力沟通的几率就会高出11%。PCMC得分每增加一分，在分娩和产后期间感到有能力沟通的几率就会高出8%。尊重和尊严推动了产前护理期间PCPC与增强能力之间的关联，而沟通和自主性则推动了PCMC与增强能力之间的关联。定性回答强调了医疗保健提供者的沟通和尊重、自主性以及伴侣和导乐的社会支持对增强能力的重要性。
讨论
以患者为中心的围产期医疗保健与在产前护理、分娩和产后期间增强与医疗保健提供者沟通的能力相关。有效的沟通和自主性对于促进患者增强能力至关重要。
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