■任期内的臀位管理指南强调选择和明智的决策。尽管如此,阴道臀位分娩(VBB)的选择,并不总是可用或可访问。我们旨在描述在主要研究中报告的女性寻求VBB的经历,并提供以证据为基础的改善这种经历的策略。
■我们对结果进行了系统的回顾和定性的荟萃综合,使用扎根理论分析方法(PROSPERO注册CRD42021262380),与文献发表在2000年1月至2022年2月之间。搜索了七个数据库。我们的评论包括有关臀位女性的文献,寻求有计划或无计划的VBB。仅考虑替代管理经验的研究(例如剖腹产,外部头部版本),那些调查医护人员的经验被排除在外。使用Covidence系统评价软件进行筛选和质量评价。使用NVivo软件(20.5.0)提取定性数据。通过基于恒定比较方法的迭代过程分析数据,具有迭代和自反代码生成过程。然后将代码排入“经验类别”,这引起了总体主题。
■我们的综述包括19项研究。我们提出了一个总体理论:“希望计划阴道臀位分娩的女性寻求相互联系的自主权”。我们的原理图,描绘这个理论,包括七个主要类别的经验:家长式医疗保健;情绪动荡;判断和自我怀疑;母亲与社会:拒绝顺从;孤立但被臀位团结;受欢迎的方向;并支持自决和自我效能。
■寻求计划VBB的女性感到脆弱,并希望与有能力和自信的医疗保健提供者联系。为了满足他们的需要,服务的设计应该使他们能够与愿意并能够支持其自主权的临床医生联系。服务还应寻求限制他们与医疗保健提供者的不尊重和判断性互动。
我们的公众参与和参与小组的成员以及OptiBreech研究的一些参与者报告说,在尝试计划阴道臀位分娩时,很难获得支持性护理。这与国家指导相冲突,强调选择和明智的决策。我们想了解更多关于寻求计划阴道臀位分娩的经验,所以我们寻找关于这个主题的研究。在我们开始并注册这个计划之前,我们做了一个仔细的计划。我们在7个在线数据库中搜索了2000年1月至2022年2月之间发表的文献。我们专注于研究怀孕臀位婴儿的妇女,试图计划阴道臀位分娩或发现其婴儿处于臀位。我们使用Covidence系统评价软件来组织和评估我们收集的研究的质量。我们收集了所有论文的主要主题和说明性引文,并进行了比较。我们经常开会讨论我们的意见,并就如何总结我们收集的信息达成一致。我们同意,总的来说,想要计划阴道臀位分娩的女性感到脆弱。他们想联系到自信,有能力的医疗保健提供者可以帮助他们尽可能安全地实现阴道分娩:“相互关联的自主权。但是他们的实际经历范围很广,包括:家长式的医疗保健;情绪动荡;判断和自我怀疑;母亲与社会:拒绝顺从;孤立但被臀位团结;受欢迎的方向;并支持自决和自我效能。我们的结论是,为了满足希望计划阴道臀位分娩的女性的需求,服务的设计应该使他们能够与愿意并能够支持其自主权的临床医生联系。服务还应限制他们与医疗保健提供者的不尊重和判断性互动。
UNASSIGNED: Guidelines for breech management at term emphasise choice and informed decision-making. Despite this, the choice of vaginal breech birth (VBB), is not always available or accessible. We aimed to describe the experiences of women seeking a VBB as reported in primary research and to offer strategies for improving this experience that are grounded in evidence.
UNASSIGNED: We conducted a systematic
review and qualitative meta-synthesis of the results, using grounded theory analysis methods (PROSPERO registration CRD42021262380), with literature published between January 2000 and February 2022. Seven databases were searched. Our
review included literature about women with breech presentation, who sought a planned or unplanned VBB. Studies considering only experiences of alternative management (e.g. caesarean, external cephalic version), and those investigating healthcare workers\' experiences were excluded. Covidence systematic
review software was used for screening and quality assessment. Qualitative data were extracted using NVivo software (20.5.0). Data were analysed through an iterative process based on constant comparison methods, with an iterative and reflexive code generation process. Codes were then arranged into \'categories of experience\', which gave rise to over-arching themes.
UNASSIGNED: Our
review included 19 studies. We present one overarching theory: \'Women who wish to plan a vaginal breech birth seek connected autonomy\'. Our schematic, depicting this theory, includes seven main categories of experience: paternalistic healthcare; emotional turmoil; judgement and self-doubt; mother vs society: refusing to conform; isolated but united by breech; welcomed direction; and supported self-determination and self-efficacy.
UNASSIGNED: Women seeking to plan a VBB feel vulnerable and wish to connect with capable and confident healthcare providers. To meet their needs, services should be designed so that they can connect with clinicians who are willing and able to support their autonomy. Services should also seek to limit their exposure to disrespectful and judgemental interactions with healthcare providers.
Members of our public involvement and engagement group and some participants in the OptiBreech research reported difficulty in attempts to access supportive care when trying to plan a vaginal breech birth. This conflicts with national guidance, which emphasises choice and informed decision-making. We wanted to understand more about the experience of seeking to plan a vaginal breech birth, so we searched for research on this topic. We made a careful plan before we started and registered this plan. We searched seven online databases for literature published between January 2000 and February 2022. We focused on studies about women pregnant with breech babies, who sought to plan a vaginal breech birth or whose baby was discovered to be breech in labour. We used Covidence systematic
review software to organise and assess the quality of the research we collected. We gathered main themes and illustrative quotes from all of the papers and compared these. We met frequently to discuss our observations and to agree on how we would summarise information we gathered. We agreed that, overall, women who wanted to plan a vaginal breech birth felt vulnerable. They wanted to connect to confident, capable healthcare providers who could help them achieve a vaginal birth as safely as possible: ‘connected autonomy.’ But their actual experiences ranged widely, including: paternalistic healthcare; emotional turmoil; judgement and self-doubt; mother vs society: refusing to conform; isolated but united by breech; welcomed direction; and supported self-determination and self-efficacy. We concluded that, to meet the needs of women who wish to plan a vaginal breech birth, services should be designed so that they can connect with clinicians who are willing and able to support their autonomy. Services should also limit their exposure to disrespectful and judgemental interactions with healthcare providers.