背景:为了应对出生时医疗干预率的上升,国际社会对促进正常分娩的兴趣日益增加(不引产,硬膜外/脊髓/全身麻醉,会阴切开术,镊子/真空,或剖腹产)。然而,关于如何最好地提高正常分娩率的证据有限。在这项研究中,我们使用回顾性方法研究了可改变和不可改变因素在经历正常分娩中的作用,自我报告的数据。
方法:在昆士兰州分娩超过四个月的妇女,澳大利亚,被邀请填写一份关于他们怀孕的偏好和经历的问卷,劳动,出生,和产后护理。使用多元逻辑回归模型分析了反应(N=5840),以确定与正常出生的四个方面的关联:分娩开始,使用麻醉,出生模式,并使用会阴切开术。然后通过组合这些模型来估计正常出生的概率。
结果:总体而言,28.7%的妇女经历了正常的分娩。初产妇的正常分娩概率降低,有剖腹产史,有多胎妊娠,年纪大了,胎龄更高,经历过与怀孕相关的健康状况(妊娠期糖尿病,低洼的胎盘,高血压),分娩期间有连续的电子胎儿监护,并且只知道他们的一些分娩和分娩护理提供者。如果女性生活在大城市以外,她们的正常生育概率更高,没有接受私人产科护理,在整个劳动过程中都有行动自由,在分娩和分娩时接受了连续性护理,没有增加劳动力,或以非仰卧位分娩。
结论:我们的发现强调了几个相关的可改变因素,包括流动性,监测,分娩和分娩期间的护理,增加正常出生的机会。促进正常分娩的重要一步是通过患者参与知情决策和在护理指南中实施这些证据来提高对这种关系的认识。
BACKGROUND: In response to rising rates of medical intervention in birth, there has been increased international interest in promoting normal birth (without induction of labour, epidural/spinal/general anaesthesia, episiotomy, forceps/vacuum, or caesarean section). However, there is limited evidence for how best to achieve increased rates of normal birth. In this study we examined the role of modifiable and non-modifiable factors in experiencing a normal birth using retrospective, self-reported data.
METHODS: Women who gave birth over a four-month period in Queensland, Australia, were invited to complete a questionnaire about their preferences for and experiences of pregnancy, labour, birth, and postnatal care. Responses (N = 5840) were analysed using multiple logistic regression models to identify associations with four aspects of normal birth: onset of labour, use of anaesthesia, mode of birth, and use of episiotomy. The probability of normal birth was then estimated by combining these models.
RESULTS: Overall, 28.7% of women experienced a normal birth. Probability of a normal birth was reduced for women who were primiparous, had a history of caesarean, had a multiple pregnancy, were older, had a more advanced gestational age, experienced pregnancy-related health conditions (gestational diabetes, low-lying placenta, high blood pressure), had continuous electronic fetal monitoring during labour, and knew only some of their care providers for labour and birth. Women had a higher probability of normal birth if they lived outside major metropolitan areas, did not receive private obstetric care, had freedom of movement throughout labour, received continuity of care in labour and birth, did not have an augmented labour, or gave birth in a non-supine position.
CONCLUSIONS: Our findings highlight several relevant modifiable factors including mobility, monitoring, and care provision during labour and birth, for increasing normal birth opportunity. An important step forward in promoting normal birth is increasing awareness of such relationships through patient involvement in informed decision-making and implementation of this evidence in care guidelines.