PDF(Pubmed)
Abstract：
OBJECTIVE: To investigate the status of the midwifery workforce and childbirth services in China and to identify the association between midwife staffing and childbirth outcomes.
METHODS: A descriptive, multicentre cross-sectional survey.
METHODS: Maternity hospitals from the eastern, central and western regions of China.
METHODS: Stratified sampling of maternity hospitals between 1 July and 31 December 2021.The sample hospitals received a package of questionnaires, and the head midwives from the participating hospitals were invited to fill in the questionnaires.
RESULTS: A total of 180 hospitals were selected and investigated, staffed with 4159 midwives, 412 obstetric nurses and 1007 obstetricians at the labour and delivery units. The average efficiency index of annual midwifery services was 272 deliveries per midwife. In the sample hospitals, 44.9% of women had a caesarean delivery and 21.4% had an episiotomy. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery (adjusted β -0.032, 95% CI -0.115 to -0.012, p<0.05) and episiotomy (adjusted β -0.171, 95% CI -0.190 to -0.056, p<0.001).
CONCLUSIONS: The rates of childbirth interventions including the overall caesarean section in China and the episiotomy rate, especially in the central region, remain relatively high. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery and episiotomy, indicating that further investments in the midwifery workforce could produce better childbirth outcomes.
METHODS: A descriptive, multicentre cross-sectional survey.
METHODS: Maternity hospitals from the eastern, central and western regions of China.
METHODS: Stratified sampling of maternity hospitals between 1 July and 31 December 2021.The sample hospitals received a package of questionnaires, and the head midwives from the participating hospitals were invited to fill in the questionnaires.
RESULTS: A total of 180 hospitals were selected and investigated, staffed with 4159 midwives, 412 obstetric nurses and 1007 obstetricians at the labour and delivery units. The average efficiency index of annual midwifery services was 272 deliveries per midwife. In the sample hospitals, 44.9% of women had a caesarean delivery and 21.4% had an episiotomy. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery (adjusted β -0.032, 95% CI -0.115 to -0.012, p<0.05) and episiotomy (adjusted β -0.171, 95% CI -0.190 to -0.056, p<0.001).
CONCLUSIONS: The rates of childbirth interventions including the overall caesarean section in China and the episiotomy rate, especially in the central region, remain relatively high. Improved midwife staffing was associated with reduced rates of instrumental vaginal delivery and episiotomy, indicating that further investments in the midwifery workforce could produce better childbirth outcomes.
摘要：
目的：调查中国助产人员和分娩服务的现状，并确定助产士人员配置与分娩结局之间的关系。
方法：描述性，多中心横断面调查。
方法：东部的妇产医院，中国中西部地区。
方法：2021年7月1日至12月31日对妇产医院进行分层抽样。样本医院收到了一揽子问卷，并邀请参与医院的首席助产士填写问卷。
结果:共选取180家医院进行调查,有4159名助产士,分娩和分娩单位的412名产科护士和1007名产科医师。年度助产服务的平均效率指数为每名助产士272次分娩。在样本医院中，44.9%的妇女进行了剖腹产，21.4%进行了会阴切开术。助产士人员配备的改善与工具性阴道分娩率降低(调整后的β-0.032,95%CI-0.115至-0.012,p<0.05)和会阴切开术率降低(调整后的β-0.171,95%CI-0.190至-0.056,p<0.001)相关。
结论：分娩干预措施的发生率，包括中国的整体剖宫产率和会阴切开率，尤其是在中部地区,保持相对较高。助产士人员配备的改善与工具性阴道分娩和会阴切开术的发生率降低有关，这表明，对助产劳动力的进一步投资可以产生更好的分娩结果。
方法：描述性，多中心横断面调查。
方法：东部的妇产医院，中国中西部地区。
方法：2021年7月1日至12月31日对妇产医院进行分层抽样。样本医院收到了一揽子问卷，并邀请参与医院的首席助产士填写问卷。
结果:共选取180家医院进行调查,有4159名助产士,分娩和分娩单位的412名产科护士和1007名产科医师。年度助产服务的平均效率指数为每名助产士272次分娩。在样本医院中，44.9%的妇女进行了剖腹产，21.4%进行了会阴切开术。助产士人员配备的改善与工具性阴道分娩率降低(调整后的β-0.032,95%CI-0.115至-0.012,p<0.05)和会阴切开术率降低(调整后的β-0.171,95%CI-0.190至-0.056,p<0.001)相关。
结论：分娩干预措施的发生率，包括中国的整体剖宫产率和会阴切开率，尤其是在中部地区,保持相对较高。助产士人员配备的改善与工具性阴道分娩和会阴切开术的发生率降低有关，这表明，对助产劳动力的进一步投资可以产生更好的分娩结果。
