自由体位联合无会阴保护技术对初产妇自我效能感及分娩体验的影响

Impact of free postures combined with unprotected perineum on self-efficacy and childbirth experience in primiparas

目的探讨自由体位联合无会阴保护技术对初产妇自我效能感及分娩体验的影响。方法选择2019年7月至2020年12月于阜阳市人民医院妇产科住院分娩的初产妇125例为研究对象,采用分层随机法分为试验组63例和对照组62例。试验组第二产程采用自由体位联合无会阴保护技术接生法,对照组第二产程采用仰卧位联合托肛保会阴接生法。比较2组分娩自我效能、会阴损伤情况、分娩结局、分娩体验等指标。结果干预后试验组初产妇的结果效能、期望效能及分娩自我效能总评分高于对照组[(127.43±15.22)分vs(116.28±13.34)分;(125.36±14.21)分vs(112.25±13.74)分;(252.79±31.32)分vs(228.53±32.14)分],差异有统计学意义(t=3.682、5.243、4.274,P均<0.05)。试验组会阴完整率、Ⅰ度裂伤率均高于对照组(22.22%vs 6.45%,52.38%vs 29.03%,χ^(2)=6.305、7.053,P均<0.05),Ⅱ度裂伤率及会阴侧切率均低于对照组(4.76%vs 17.74%,20.63%vs 46.77,χ^(2)=5.294、9.570,P均<0.05)。试验组自然分娩率显著高于对照组(84.1%vs 58.1%,χ^(2)=10.351,P<0.05),第二产程时间短于对照组[(46.14±7.23)min vs(58.26±8.31)min,t=8.703,P<0.05]。试验组自身能力、专业支持、安全感知、参与性、分娩体验总分高于对照组[(25.41±4.23)分vs(22.28±3.46)分;(20.32±2.51)分vs(18.76±2.16)分;(18.82±3.20)分vs(16.65±2.42)分;(17.18±2.34)分vs(15.62±3.21)分;(81.73±10.25)分vs(73.31±9.56)分],差异有统计学意义(t=4.524、3.722、4.271、3.108、4.748,P均<0.05)。结论自由体位联合无会阴保护技术有助于促进初产妇分娩自我效能的养成,减少会阴损伤程度,改善分娩结局,增强初产妇分娩体验感。

Objective To investigate the impact of free postures combined with unprotected perineum on self-efficacy and childbirth experience in primiparas.Methods A total of 125 primiparas hospitalization at Department of Obstetrics and Gynecology,Fuyang People's Hospital from July 2019 to December 2020 were selected and divided into either an experimental group(63 cases)or a control group(62 cases)using stratified randomization method.Patients in the experimental group adopted free postures combined with unprotected perineum delivery,while patients in the control group adopted the supine position combined with anal support and perineal protection in the second stage of labor.Childbirth self efficacy,perineal injury,childbirth outcome,and childbirth experience were compared between the two groups.Results The scores of result efficacy,expected efficacy,and childbirth self-efficacy were significantly higher in the experimental group than in the control group[(127.43±15.22)vs(116.28±13.34),(125.36±14.21)vs(112.25±13.74),and(252.79±31.32)vs(228.53±32.14);t=3.682,5.243,and 4.274,respectively;P<0.05 for all].In the experimental group,the perineal integrity rate and first degree laceration rate were significantly higher than those of the control group(22.22%vs 6.45%and 52.38%vs 29.03%;χ^(2)=6.305 and 7.053,respectively;P<0.05 for both),but second degree laceration rate and perineal lateral incision rates were significantly lower than those of the control group(4.76%vs 17.74%and 20.63%vs 46.77%;χ^(2)=5.294 and 9.570,respectively;P<0.05 for both).In the experimental group,the natural delivery rate was higher than the control group(84.1%vs 58.1%,χ^(2)=10.351,P<0.05),the duration of the second stage of labor was shorter than that of the control group[(46.14±7.23)min vs(58.26±8.31)min,t=8.703,P<0.05].In the experimental group,the scores of self-competence,professional support,safety perception,participation,and delivery experience were significantly higher than those of the control group[(25.41±4.23)vs(22.28±3.46),(20.32±2.51)vs(18.76±2.16),(18.82±3.20)vs(16.65±2.42),(17.18±2.34)vs(15.62±3.21),(81.73±10.25)vs(73.31±9.56);t=4.524,3.722,4.271,3.108,and 4.748,respectively;P<0.05 for all].Conclusion Free postures combined with unprotected perineum delivery can promote the development of self-efficacy during childbirth in primiparas,reduce perineal injury degree,improve childbirth outcome,and enhance childbirth experience.