产妇对不同分娩方式非医学性因素的认知行为调查研究

A survey on maternal cognitive behaviors related to non-medical factors in different modes of delivery

目的探讨产妇对不同分娩方式非医学影响因素的认知行为情况,为临床产科降低剖宫产率及相关研究提供依据。方法选取2017年1月至2018年9月本院接收的226例行剖宫产产妇(无剖宫产指征)为观察组,同期选择226例阴道分娩产妇为对照组。采用本院自行设计的调查问卷对2组产妇的认知行为情况予以调查分析,观察比较2组产妇对不同分娩方式(阴道分娩、剖宫产)相关认知的不同单因素差异,并建立非条件Logistic予以多因素回归分析。结果观察组产妇的经济条件优越、城市居住以及脑力劳动比例明显高于对照组,差异均有统计学意义(P<0.05);观察组产妇对形体美、母婴安全、吉利、孩子聪明、阴道松弛影响性生活以及阴道分娩太痛苦等因素更加关注,对照组产妇则主要关注阴道分娩费用低廉、产后恢复较快等。2组产妇在听从医生、行剖宫产意向、家属、惧怕阴道分娩、剖宫产是一种完美分娩、中介媒体不同分娩方式介绍等认知方面比较,差异有统计学意义(P<0.05)。经Logistic多因素分析显示剖宫产是完美分娩、阴道松弛影响性生活、医生对分娩方式的介绍与建议、行剖宫产意向以及阴道分娩是自然过程共5个因素对产妇选择分娩方式产生较大的影响,其中阴道分娩是自然过程属于保护性因素。结论非医学性影响因素的错误认知行为是造成无医学指征产妇选择行剖宫产的主要原因,临床应重视分娩方式的宣教,理性选择剖宫产,了解其利弊,提高产科质量。

Objective To investigate the maternal cognitive behaviors related to non-medical factors in different modes of delivery,and to provide evidence for clinical obstetric practice and related study to reduce cesarean sec-tion rate.Methods Between January 2017 and September 2018,a total of 226 cases of cesarean section(not com-pulsorily indicated for cesarean section)in our hospital were selected as observation group.Another 226 cases of vagi-nal delivery were selected as the control group.A self-designed questionnaire was used to investigate and analyze the cognitive behaviors of the two groups of women.The maternal cognition about modes of delivery(vaginal delivery vs cesarean section)in the two groups was compared for difference using univariate analysis,and further studied in non-conditional multivariate Logistic analysis.Results Significantly higher proportions of mothers with high-income,urban residency and brainwork professions were found in the observation group than in the control group,with statistical difference(P<0.05).The observation group mothers concerned more about physical beauty,mother and child safety,luckiness,smart offspring,compromised sexual life due to relaxed vagina and painful vaginal delivery and other re-lated factors,whereas the control group of women mainly concerned about lower expense with vaginal delivery,quick-er postnatal recovery and so on.The two groups of women showed significant differences in following the doctor ad-vice,intention for cesarean section,family members,fear for vaginal delivery,cesarean section is a perfect delivery mode,agency/media introduction about delivery modes and other cognitive issues(P<0.05).Logistic multivariate analysis showed that five factors,i.e.,cesarean delivery is perfect delivery mode,compromised sexual life due to relaxed vagina,doctor introduction and recommendation about delivery mode,intention for cesarean section and vaginal de-livery is a natural mode of delivery,were associated with maternal choice of delivery mode.Among these,the factor vaginal delivery is a natural mode of delivery was a protective factor.Conclusion Incorrect cognitive behaviors arising from non-medical influential factors is the main reason for choice of cesarean section without medical indications.In clinical practice,it is important to enhance education about delivery modes,so that maternal choice of cesarean section would be more rational while outbalancing the disadvantages,and ultimately lead to improved quality of ob-stetrics.