Practices of skilled birth attendants during labour, birth and the immediate postpartum period in Cambodia
Practices of skilled birth attendants during labour, birth and the immediate postpartum period in Cambodia
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DOI：
10.1016/j.midw.2012.01.010
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发表时间：
2013-04-01
期刊：
影响因子：
2.7
通讯作者：
Whelan, Anna Klinken
中科院分区：
文献类型：
--
作者：
Ith, Ponndara;Dawson, Angela;Whelan, Anna Klinken
目标：柬埔寨的产妇和围产期发病率和死亡率很高。由熟练助产士在支持性工作环境中提供优质护理是降低发病率和死亡率的一项重要战略。柬埔寨很少强调审查这一问题。本研究的目的是建立SBA在分娩、分娩和产后期间报告的做法及其影响因素。方法：采用描述性定性设计，在柬埔寨一个省的两个保健中心和三个转诊医院与具有助产技能的助产士、护士和医生进行深入访谈和焦点小组讨论。使用专题框架分析了数据。研究结果：SBA的实践并不总是符合已知的降低发病率和死亡率的循证标准。确定了十个相互关联的主题，它们描述了小企业管理局的做法模式。它们是：照顾劳动妇女的技能；提供劳动方面的支助；第二产程的干预措施；第三产程管理；分娩时的清洁；新生儿的即时护理和产后即时护理；缺乏政策和权威；害怕诉讼；工作量大，人力资源不足；财政激励和社会经济影响。结论：在分娩、分娩和产后即时护理过程中，循证标准与目前的SBA实践存在差距。这主要是由于缺乏支持性的工作环境。对实践的影响：这项研究的结果为产妇保健服务、劳动力规划人员和决策者提供了宝贵的信息，有助于不断提高产妇保健的质量。研究结果强调了对可能提高孕产妇保健质量的实践的影响。向决策者提出了建议，需要进一步研究，以发展理论和建议，改进柬埔寨的小企业管理局做法，使柬埔寨妇女和新生儿受益。(C) 2012 Elsevier Ltd.版权所有。
Objective: maternal and perinatal morbidity and mortality rates in Cambodia are high. The provision of quality care by skilled birth attendants (SBAs) in a supportive working environment is an important strategy to reduce morbidity and mortality. There has been little emphasis on examining this issue in Cambodia. The objective of this study was to establish SBA reported practices during labour, birth and the immediate postpartum periods and the factors affecting this.Methods: a descriptive qualitative design was employed using in-depth interviews and focus group discussions with midwives, nurses and doctors with midwifery skills in two health centres and three referral hospitals in one province of Cambodia. Data were analysed using a thematic framework.Findings: SBA practice is not always consistent with evidence-based standards known to reduce morbidity and mortality. Ten inter-related themes emerged, which described patterns of SBA practice, were identified. These were: skills in the care of labouring women; provision of support in labour; interventions in the second stage of labour; management of the third stage of labour; cleanliness during birth; immediate care of the newborn infant and immediate postnatal care; lack of policy and authority; fear of litigation; workload and lack of human resources; and financial incentives and socio-economic influences.Conclusions: a gap exists between evidence-based standards and current SBA practice during labour, birth and the immediate postpartum care. This is largely driven by the lack of a supportive working environment.Implications for practice: the findings of this research provide maternal health services, workforce planners and policy makers with valuable information to contribute to the continuous quality improvement of maternity care. The findings highlight implications for practice that may improve the quality of maternal health care. Recommendations for decision makers were made and further research is needed in order to develop theories and recommendations to improve SBA practice in Cambodia, to the benefit of the Cambodia women and newborn babies. (C) 2012 Elsevier Ltd. All rights reserved.