A cross-sectional survey of policies guiding second stage labor in urban Japanese hospitals, clinics and midwifery birth centers.
A cross-sectional survey of policies guiding second stage labor in urban Japanese hospitals, clinics and midwifery birth centers.
复制标题
一项针对城市日本医院，诊所和助产士出生中心的政策的横断面调查。
DOI：
10.1186/s12884-016-0814-2
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发表时间：
2016-02-24
影响因子：
3.1
通讯作者：
Eto H
中科院分区：
文献类型：
--
作者：
Baba K;Kataoka Y;Nakayama K;Yaju Y;Horiuchi S;Eto H
日本助产士学会(Japan Academy Of Midwifery)为低风险分娩制定并传播了《2012年助产士护理循证指南》，以期在日本实现更统一的分娩护理标准。这项研究的目的是横断面调查日本医院、诊所和助产士中心在第二产程护理方面的政策执行情况，并将这些政策与助产士指南中的建议进行比较。这项研究是在日本关东地区的四个主要城市化地区(如东京)进行的。答复者为机构负责人(产科医生/助产士)、产科护士管理人员(包括助产士)或精通目标机构日常护理的其他护士/助产士。准则执行情况调查表由12个项目组成。数据收集自2010年10月至2011年7月。在684家机构中，总体回应为255家(37%)。在所有回复中，46%是医院，26%是诊所，28%是助产中心。很少有机构报告会按摩教育适用于“几乎所有病例”。使用“主动分娩”的都是助产中心、56%的医院和32%的诊所。很少有机构使用水中分娩。大多数医院(73%)和诊所(80%)，但少数助产中心(39%)报告说，关于在会阴上使用热敷料的做法没有得到实施。很少有助产中心(10%)和更多的医院(38%)和诊所(50%)将valsalva作为常规护理。许多医院(90%)和诊所(88%)和较少的助产中心(54%)提供亲身操作技术，在分娩期间提供会阴支持。大多数机构使用消毒液进行会阴消毒。很少有机构常规使用会阴切开术来经产，但在医院(21%)和诊所(25%)，初产妇的常规使用略多。所有受访者使用的眼底压力都与指南一致。实施手膝位矫正胎儿异常旋转的机构不多。这项调查提供了关于日本四个大都市地区三种类型的指导第二阶段分娩的机构所制定的政策的新信息。不同机构的做法存在着很大的差异。在报告的助产士政策和循证助产士指南之间也有许多差距，因此日本需要新的战略来重新调整机构的护理政策和循证指南。
The Japan Academy of Midwifery developed and disseminated the ‘2012 Evidence-based Guidelines for Midwifery Care (Guidelines for Midwives)’ for low-risk births to achieve a more uniform standard of care during childbirth in Japan. The objective of this study was to cross-sectional survey policy implementation regarding care during the second stage of labor at Japanese hospitals, clinics, and midwifery birth centers, and to compare those policies with the recommendations in Guidelines for Midwives. This study was conducted in the four major urbanized areas (e.g. Tokyo) of the Kanto region of Japan. Respondents were chiefs of the institutions (obstetricians/midwives), nurse administrators (including midwives) of the obstetrical departments, or other nurse/midwives who were well versed in the routine care of the targeted institutions. The Guidelines implementation questionnaire comprised 12 items. Data was collected from October 2010 to July 2011. The overall response was 255 of the 684 institutions (37 %). Of the total responses 46 % were hospitals, 26 % were clinics and 28 % were midwifery birth centers. Few institutions reported perineal massage education for ‘almost all cases’. Using ‘active birth’ were all midwifery birth centers, 56 % hospitals and 32 % clinics. Few institutions used water births. The majority of hospitals (73 %) and clinics (80 %) but a minority (39 %) of midwifery birth centers reported ‘not implemented’ about applying warm compress to the perineum. Few midwifery birth centers (10 %) and more hospitals (38 %) and clinics (50 %) had a policy for valsalva as routine care. Many hospitals (90 %) and clinics (88 %) and fewer midwifery birth centers (54 %) offered hands-on technique to provide perineal support during birth. A majority of institutions used antiseptic solution for perineal disinfection. Few institutions routinely used episiotomies for multiparas, however routine use for primiparas was slightly more in hospitals (21 %) and clinics (25 %). All respondents used fundal pressure as consistent with guidelines. Not many institutions implemented the hands and knees position for correcting fetal abnormal rotation. This survey has provided new information about the policies instituted in three types of institutions guiding second stage labor in four metropolitan areas of Japan. There existed considerable differences among institutions’ practice. There were also many gaps between reported policies and evidence-based Guidelines for Midwives, therefore new strategies are needed in Japan to realign institution’s care policies with evidenced based guidelines.