孕妇分娩计划的实施效果评价

Evaluation of the effectiveness of birth plan for pregnant women

目的评价孕妇分娩计划的制订实施对孕妇分娩结局、产时支持性服务利用度及满意度的影响。方法便利选取2015年7月—12月在上海市某三级甲等医院建卡并定期产检的正常孕晚期孕妇310例,在接受常规产前检查和孕期指导的基础上,参加由助产士门诊为其制订并执行的分娩计划,追踪随访其分娩方式、会阴侧切率、产时服务利用度及满意度等。结果产妇的剖宫产率为25.5%,第一产程和总产程时间、引产率和医疗手段加速产程率、会阴侧切率均低于医院2014年7月—12月同期产妇的相关数据。参加分娩计划并成功阴道分娩的231例产妇均未发生Ⅲ度及以上会阴撕裂。产妇的陪伴分娩率、第一产程自由体位及分娩球应用率、对孕晚期产检及分娩服务的满意度均高于2014年同期分娩产妇。结论孕期分娩计划的实施能够减少产时医疗干预,提高孕妇分娩支持性服务的利用度,提升孕妇对孕晚期产检和分娩过程的满意度,一定程度上改善了分娩结局。

Objective To evaluate the effectiveness of birth plan on childbirth outcomes,utilization and satisfaction of intrapartum supportive care among pregnant women. Methods Three hundred and ten normal pregnant women during third trimester of pregnancy who had made registration and received routine antenatal checkups in one tertiary hospital in Shanghai from July to December,2015 were selected. They participated in making birth plans with their advanced midwifery practitioners in the midwives＇ antenatal clinic besides routine prenatal examination and pregnancy guidance. Indicators including modes of delivery,rates of lateral episiotomies ,utilization and satisfaction of intrapartum care were compared. Results Cesarean section rate（25.5%）,length of 1st and total labor stages,intrapartum intervention rate and rate of lateral episiotomies in this study were lower than those of women from July to December,2014. Two hundred and thirty one women who delivered vaginally did not have any III degree or more severe laceration. The rate of accompany delivery,free positions during 1st labor stage and utilization of birth balls,satisfaction with antenatal care during third trimester and intrapartum care were higher than those of women from July to December,2014. Conclusion Birth plans for pregnant women can reduce intrapartum medical interventions,enhance utilization and satisfaction of midwifery care,and improve pregnant women＇s childbirth outcomes to some degree.