Fisher J, Smith A, Astbury J
Key Centre for Women's Health in Society, Department of Public Health and Community Medicine, University of Melbourne, Australia.
J Psychosom Obstet Gynaecol. 1995 Mar;16(1):1-9. doi: 10.3109/01674829509025651.
In this study 242 nulliparous pregnant women completed standardized psychometric questionnaires and semi-structured interviews in the latter half of pregnancy and again 4-6 weeks postpartum. Discriminant function analysis revealed that the use of operative obstetric interventions was measurably influenced by psychosocial factors. Privately insured women were significantly more likely to experience instrumentally assisted (relative risk = 1.53, 95% CI: 1.05, 2.25) and Caesarean (relative risk = 1.91, 95% CI: 1.05, 3.46) deliveries than those receiving care in the public hospital system. The likelihood of experiencing these procedures was increased further among those who in late pregnancy were thinking clearly, had high self-esteem, mature means of dealing with anxiety, were confident in their knowledge of childbirth procedures and in secure partnerships with highly educated men. There was no evidence that either elevated anxiety or abnormalities of personality contributed to obstetric outcome. These findings indicate that obstetric decision-making is significantly influenced by patient personality and socioeconomic circumstances. In particular, they suggest that fear of malpractice litigation, physician convenience factors and the response of obstetricians to assured, well pregnancy-educated pregnant women may be influencing the use of operative intervention in delivery.
在本研究中，242名未生育的孕妇在妊娠后半期完成了标准化心理测量问卷和半结构化访谈，并在产后4 - 6周再次进行。判别函数分析显示，社会心理因素对产科手术干预的使用有显著影响。与在公立医院系统接受治疗的女性相比，拥有私人保险的女性更有可能接受器械辅助分娩（相对风险 = 1.53，95%置信区间：1.05，2.25）和剖宫产（相对风险 = 1.91，95%置信区间：1.05，3.46）。在妊娠晚期思维清晰、自尊心强、有成熟的焦虑应对方式、对分娩程序知识有信心且与受过高等教育的男性建立稳固伴侣关系的女性中，经历这些分娩方式的可能性进一步增加。没有证据表明焦虑加剧或人格异常会影响产科结局。这些发现表明，产科决策受患者个性和社会经济状况的显著影响。特别是，它们表明对医疗事故诉讼的担忧、医生的便利因素以及产科医生对自信且接受过良好孕期教育的孕妇的反应，可能正在影响分娩中手术干预的使用。
