The decision of what kind of labor that should be held is intermittently generating a great debate in Brazil. The growth in the number of cesarean sections has raised worries in some of the involved sectors of the soc...The decision of what kind of labor that should be held is intermittently generating a great debate in Brazil. The growth in the number of cesarean sections has raised worries in some of the involved sectors of the society. It was proposed to investigate the factors which lead the women to take this decision, trying to understand the principle involved. A bibliographic review about the subject was made. The research happened in the town of Formiga, where some data were collected in two hospitals—public and private —about the number of labors during two months. Subsequently, the obstetricians and a group of pregnant women were submitted to a questionnaire, the answers were compiled and transformed into graphs which were analyzed. Finally, the data were compared with the related literature. The number of cesarean sections in the town was above the standard recommended. According to the obstetricians, the main reason would be the preference of the pregnant women, fact which was not confirmed by them, that discrepancy was confirmed by the literature. The level of information about the clinical indications for the type of labor was considered satisfactory by the doctors and the pregnant women, data contestable by the academics. The fear and the pain were identified by obstetricians and pregnant women as a predominant factor for the preference of cesarean sections, provided that, according to the literature, shows the precariousness of information for pregnant women about the normal birth. Another important data is that the doctors can have an important role in the kind of labor to be made. According to the obstetricians, their role would be very limited, but according to some pregnant women, they did trust in the doctors which should be the ideal labor for them. The analysis of most of the data collected shows a discrepancy between the information of pregnant women and obstetricians. Both sides involved in the issue do not admit as responsible for the elevate number of cesarean sections, so, some new approaches are needed for analysis. This analysis and diagnosis indicate the next step of the research: the supervision of the pregnant women, since the beginning of the gestation until the birth, trying to figure out the real factors which lead them to decide what kind of delivery should be taken.展开更多
目的系统评价认知行为疗法(CBT)对分娩恐惧(FOC)孕妇的干预效果。方法计算机检索中国知网(CNKI)、万方、维普、中国生物医学文献数据库、Cochrane Library、PubMed、Web of Science及Embase数据库中关于CBT对FOC孕妇干预效果的随机对照...目的系统评价认知行为疗法(CBT)对分娩恐惧(FOC)孕妇的干预效果。方法计算机检索中国知网(CNKI)、万方、维普、中国生物医学文献数据库、Cochrane Library、PubMed、Web of Science及Embase数据库中关于CBT对FOC孕妇干预效果的随机对照试验(RCT)和类实验性研究,检索时限为建库起至2021年7月31日。由2名研究者独立按照纳入与排除标准进行文献筛选、资料提取和质量评价,采用RevMan 5.3软件进行Meta分析。结果最终纳入6项RCT和2项类实验性研究,总样本量为1578例孕妇。Meta分析结果显示:CBT干预可降低孕妇的FOC[SMD=-1.27,95%CI(-2.17,-0.37),P<0.05]、降低剖宫产率[OR=0.71,95%CI(0.54,0.92),P<0.05]、降低剖宫产的分娩意向[OR=0.50,95%CI(0.26,0.96),P<0.05]及缩短总产程[WMD=-1.18,95%CI(-2.07,-0.30),P<0.05],但在孕妇分娩体验[OR=1.27,95%CI(0.89,1.82),P>0.05]和焦虑[SMD=-2.01,95%CI(-5.75,1.72),P>0.05]方面比较,差异无统计学意义。结论CBT干预可降低孕妇FOC、剖宫产率和剖宫产分娩意向,并缩短总产程,但在孕妇分娩体验和焦虑状况方面效果尚不明确。展开更多
文摘The decision of what kind of labor that should be held is intermittently generating a great debate in Brazil. The growth in the number of cesarean sections has raised worries in some of the involved sectors of the society. It was proposed to investigate the factors which lead the women to take this decision, trying to understand the principle involved. A bibliographic review about the subject was made. The research happened in the town of Formiga, where some data were collected in two hospitals—public and private —about the number of labors during two months. Subsequently, the obstetricians and a group of pregnant women were submitted to a questionnaire, the answers were compiled and transformed into graphs which were analyzed. Finally, the data were compared with the related literature. The number of cesarean sections in the town was above the standard recommended. According to the obstetricians, the main reason would be the preference of the pregnant women, fact which was not confirmed by them, that discrepancy was confirmed by the literature. The level of information about the clinical indications for the type of labor was considered satisfactory by the doctors and the pregnant women, data contestable by the academics. The fear and the pain were identified by obstetricians and pregnant women as a predominant factor for the preference of cesarean sections, provided that, according to the literature, shows the precariousness of information for pregnant women about the normal birth. Another important data is that the doctors can have an important role in the kind of labor to be made. According to the obstetricians, their role would be very limited, but according to some pregnant women, they did trust in the doctors which should be the ideal labor for them. The analysis of most of the data collected shows a discrepancy between the information of pregnant women and obstetricians. Both sides involved in the issue do not admit as responsible for the elevate number of cesarean sections, so, some new approaches are needed for analysis. This analysis and diagnosis indicate the next step of the research: the supervision of the pregnant women, since the beginning of the gestation until the birth, trying to figure out the real factors which lead them to decide what kind of delivery should be taken.
文摘目的系统评价认知行为疗法(CBT)对分娩恐惧(FOC)孕妇的干预效果。方法计算机检索中国知网(CNKI)、万方、维普、中国生物医学文献数据库、Cochrane Library、PubMed、Web of Science及Embase数据库中关于CBT对FOC孕妇干预效果的随机对照试验(RCT)和类实验性研究,检索时限为建库起至2021年7月31日。由2名研究者独立按照纳入与排除标准进行文献筛选、资料提取和质量评价,采用RevMan 5.3软件进行Meta分析。结果最终纳入6项RCT和2项类实验性研究,总样本量为1578例孕妇。Meta分析结果显示:CBT干预可降低孕妇的FOC[SMD=-1.27,95%CI(-2.17,-0.37),P<0.05]、降低剖宫产率[OR=0.71,95%CI(0.54,0.92),P<0.05]、降低剖宫产的分娩意向[OR=0.50,95%CI(0.26,0.96),P<0.05]及缩短总产程[WMD=-1.18,95%CI(-2.07,-0.30),P<0.05],但在孕妇分娩体验[OR=1.27,95%CI(0.89,1.82),P>0.05]和焦虑[SMD=-2.01,95%CI(-5.75,1.72),P>0.05]方面比较,差异无统计学意义。结论CBT干预可降低孕妇FOC、剖宫产率和剖宫产分娩意向,并缩短总产程,但在孕妇分娩体验和焦虑状况方面效果尚不明确。
