基于医患视角的非医疗需要剖宫产原因分析及应对策略

Reasons and Solutions for Cesarean Section Without Medical Indications: From Doctor and Patient Perspective

目的探讨非医疗需要剖宫产原因及其应对策略。方法医院通过问卷调查的形式总结医患双方非医疗需要剖宫产原因,并运用实证分析各因素对医患双方的影响作用,将导致非医疗需要剖宫产的因素按照敏感度分为强作用因素、中等作用因素和弱作用因素。结果选取了40位产科医务人员和250名选择非医疗需要剖宫产的产妇进行了问卷调查,收回有效问卷产科医务人员38份,选择非医疗需要剖宫产的产妇240份。导致非医疗需要剖宫产原因中,医生方面长时间观察产程、医疗风险及患方的安全可靠、产科医生的建议为强作用因素,医生方面胎儿评估偏大、高龄初产及患方的减少分娩疼痛、害怕自然分娩过程中转剖宫产等为中等作用因素;熟人、医疗费用、剖宫产的孩子聪明、挑时辰等为弱作用因素。结论加强对孕产妇及其家属宣教、加强产科的院内安保措施、加强对产科医生的业务学习、加强医患沟通,开展相关助产项目等措施有助于降低非医疗需要剖宫产。

Objective To analyze the reasons for cesarean section without medical indications and its coping strategies. Method The hospital summarized doctor and patient factors for cesarean section without medical indications through questionnaires, and analyzed their influence on doctors and patients using empirical analysis, dividing them into strong factors, moderate factors and weak factors. Result 40 obstetric staff and 250 puerperae who undertook cesarean section without medical indications accepted the survey, and 38 obstetric staff and 240 puerperae questionnaires were collected. Strong factors included doctor factors, namely long time observation of stages of labor and medical risks, and patient factors, namely pursuit of safety and reliability and suggestions of obstetricians. Moderate factors included doctor factors, namely large infant size, primipara at advanced age, and patient factors, namely reducing delivery pain, fear for converting to cesarean section during spontaneous labor. Weak factors included acquaintance, medical cost, thinking that cesarean section babies were smarter, preference for hour. Conclusion Strengthening education for pregnant women and their families, strengthening security measures in obstetric department, reinforcing obstetrician＇s technique and knowledge learning, improving doctor-patient communication, and carrying out aspirator delivery projects can help reduce cesarean section without medical indications.