青海牧区藏族育龄妇女的分娩现状分析

Current Situation of Delivery of Tibetan Women of Childbearing Age in Qinghai Pastoral Area

目的调查藏族牧区育龄妇女的分娩现状,并分析其影响因素。方法选取2014年6月19—23日参加青海大学泽库县惠民服务活动的204例符合纳入标准的育龄妇女为调查对象,其中恰科日乡80例（39.2%）、泽曲镇79例（38.7%）、其他乡45例（22.1%）。收集204例育龄妇女的基础资料,包括文化程度、婚姻状况、职业、孕产史;并进一步调查有生产史妇女的分娩现状,包括助产人员的选择、分娩地点的选择、分娩方式的选择、妊娠期不适症状、产前检查次数、孕妇接受妊娠期相关教育情况、配偶接受妊娠期相关教育情况、现代交通工具、经济状况,分析有孕产史妇女选择不同助产人员、分娩地点的影响因素。结果 204例育龄妇女中,文化程度：文盲155例（76.0%）,小学32例（15.7%）,初中10例（4.9%）,高中及以上7例（3.4%）;婚姻状况：未婚20例（9.8%）,已婚160例（78.3%）,离异17例（8.3%）,丧偶7例（3.4%）;职业：畜牧业118例（57.8%）,家庭主妇25例（12.3%）,临时工25例（12.3%）,个体经商12例（5.9%）,其他职业24例（11.7%）;无孕产史11例（5.4%）,有孕产史193例（94.6%）。193例有孕产史的妇女中,有生产史191例（其中初产妇26例、经产妇165例）,无生产史2例。初产妇选择医务人员助产率及医疗机构分娩率均高于经产妇（P〈0.05）。初产妇与经产妇不同分娩方式选择率比较,差异无统计学意义（P〉0.05）。初产妇中未婚6例（23.1%）,已婚16例（61.5%）,离异3例（11.5%）,丧偶1例（3.9%）;有畜牧业资产19例（73.1%）,无畜牧业资产7例（26.9%）。产前检查次数为1~4次的初产妇选择医务人员助产率高于产前检查次数为0次的初产妇（P〈0.05）。有无现代交通工具的初产妇助产人员、分娩地点选择情况比较,差异有统计学意义（P〈0.05）;不同产前检查次数的初产妇分娩地点选择情况比较,差异无统计学意义（P〉0.05）;不同年龄、妊娠期有无不适症状、孕妇是否接受妊娠期相关教育、配偶是否接受妊娠期相关教育、不同经济状况的初产妇助产人员、分娩地点选择情况比较,差异无统计学意义（P〉0.05）。经产妇中未婚4例（2.4%）,已婚142例（86.1%）,离异13例（7.9%）,丧偶6例（3.6%）;有畜牧业资产117例（70.9%）,无畜牧业资产48例（29.1%）。胎次≥3次的经产妇选择医务人员助产率和医疗机构分娩率低于胎次为2次的经产妇,产前检查次数≥1次的经产妇选择医务人员助产率和医疗机构分娩率高于产前检查次数为0次的经产妇（P〈0.05）。孕妇是否接受妊娠期相关教育、配偶是否接受妊娠期相关教育的经产妇助产人员选择情况比较,差异有统计学意义（P〈0.05）;不同经济状况的经产妇分娩地点选择情况比较,差异有统计学意义（P〈0.05）;不同经济状况的经产妇助产人员选择情况比较,差异无统计学意义（P〉0.05）;孕妇是否接受妊娠期相关教育、配偶是否接受妊娠期相关教育的经产妇分娩地点选择情况比较,差异无统计学意义（P〉0.05）;不同年龄、现代交通工具的经产妇助产人员、分娩地点选择情况比较,差异无统计学意义（P〉0.05）。结论青海牧区藏族育龄妇女选择医疗机构分娩率及获得医务人员助产率均较低,并且在选择医务人员助产及在医疗机构进行分娩的诸多原因中,有现代交通工具、胎次、妊娠期出现不适症状、产前检查等是影响因素,因此,应结合牧区实际情况,有针对性地对育龄妇女开展健康教育,并加强妇幼保健机构及乡镇卫生院产科建设等健康促进措施的落实。

Objective To investigate the delivery status of Tibetan pastoral women of childbearing age,and analyze its influencing factors. Methods In line with the inclusion criteria for the survey, 204 women of childbearing age who participated in service activities that benefited the people in Zeku County,Qinghai University from June 19 to 23 in 2014 were selected as the research objects. Among them,80（ 39. 2%） were from Qiakeri township,79（ 38. 7%） from Zequ township,and 45（ 22. 1%） from other townships. The basic information of 204 women of childbearing age was collected, including educational level, marital status, occupation, pregnancy and delivery history; the delivery situation of women who had production history was further investigated,including the selection of midwives,the choice of delivery location,the choice of delivery mode, discomfort symptoms during pregnancy, frequency of prenatal examination, pregnancy- related education receiving status of pregnant women,pregnancy- related education receiving status of the spouse,modern means of transport,economic status; and the influenicing factors of pregnant women choosing different midwives and delivery locations were analyzed. Results Among the 204 women in childbearing period,their educational level： 155（ 76. 0%） were illiteracy,32（ 15. 7%） were primary school level,10（ 4. 9%） were junior high school level,and 7（ 3. 4%） of were high school level or above; marital status： 20（ 9. 8%） of them were unmarried,160（ 78. 5%） were married,17（ 8. 3%） were divorced,and 7（ 3. 4%） of were widowed; occupation： 118（ 57. 8%） were in animal husbandry,25（ 12. 3%） were housewives,25（ 12. 3%） were temporary workers,12（ 5. 9%） of individual busiess households,and 24（ 11. 7%） with others occupations;11（ 5. 4%） cases with no pregnancy history,193（ 94. 6%） had pregnancy and delivery history. Among the 193 women who had pregnancy and delivery history,191 had production history（ including 26 uniparas and 165 multiparas）,and 2 have no history of production. The rate of uniparas choosing medical midwives and institutions was higher than that of multiparas（ P〈0. 05）. There was no significant difference between uniparas and multiparas in the choice of selecting different delivery modes（ P〈0. 05）.Among the uniparas,6（ 23. 1%） were unmarried,16（ 61. 5%） married,3（ 11. 5%） divorced,and 1（ 3. 9%） widowed;19（ 73. 1%） owned animal husbandry assets,7（ 26. 9%） had no animal husbandry assets. The rate of uniparas with the number of antenatal visits was 1 to 4 in selecting midwives was higher than that of uniparas with zero antenatal visit（ P〈0. 05）. There was significant difference in the selection status of midwives and delivery locations between uniparas with or without modern means of transport（ P〈0. 05）; there was no significant difference in the selection status of delivery locations among uniparas with different times of prenatal examination（ P〈0. 05）; there was no significant difference in the selection status of midwives and delivery locations among uniparas of different ages, with or without discomfort symptoms during pregnancy, receiving or not receiving pregnancy- related education,whether their spouses receiving or not receiving pregnancy- related education,and of different economic conditions（ P〈0. 05）. Among the multiparas,4（ 2. 4%） were unmarried,142（ 86. 1%） married,13（ 7. 9%） divorced,and 6（ 3. 6%） widowed; 117（ 70. 9%） owned animal husbandry assets,48（ 29. 1%） had no animal husbandry assets. The rate of multiparas with the fetal times≥3 in selecting midwives and delivery locations was lower than that of multiparas with fetal times were 2,the rate of multiparas with the number of antenatal visits≥1 in selecting midwives and delivery locations was higher than that of multiparas with zero antenatal visit（ P〈0. 05）. There was significant difference in the selection status of midwives among multiparas and their spouses receiving or not receiving pregnancy- related education（ P〈0. 05）; there was significant difference in the selection status of delivery locations among multiparas of different economic conditions（ P〈0. 05）; there was no significant difference in the selection status of midwives among multiparas of different economic conditions（ P〈0. 05）; there was no significant difference in the selection status of delivery locations among multiparas and their spouses receiving or not receiving pregnancy- related education（ P〈0. 05）; there was no significant difference in the selection status of midwives and delivery locations among multiparas of different ages and modern means of transport（ P〈0. 05）. Conclusion The delivering rate of selecting medical institutions and midwifery rate of medical personnel of Tibetan women of childbearing age in Qinghai pastoral area were rather low,and in the choice of medical personnel in midwifery and medical institutions in the delivery of many reasons,families having modern means of transport,fetal times,discomfort symptoms occur during pregnancy,and prenatal examination are the influence factors of delivering in selecting medical midwives and institutions. Therefore, health education targeted at women of childbearing age should be developed according to the actual situation of pastoral areas,and the obstetrics construction of maternity and child care institutions and township hospitals should be strengthened to promote implementation of such health promotion measures.