Obstetrician-gynecologists' counseling regarding postpartum sterilization
Obstetrician-gynecologists' counseling regarding postpartum sterilization
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DOI：
10.2147/ijwh.s169674
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发表时间：
2018-01-01
影响因子：
2.3
通讯作者：
Schulkin, Jay
中科院分区：
文献类型：
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作者：
Arora, Kavita Shah;Castleberry, Neko;Schulkin, Jay
引言：妇产科医生（ob-gyns）在为患者提供有关绝育的咨询，提供替代避孕方法，满足绝育请求以及由于个人道德信仰而无法提供服务的患者转诊方面发挥着重要作用。因此，我们试图更好地描述妇产科关于产后绝育的咨询实践。材料和方法：这是一项前瞻性的、基于电子调查的研究，研究对象是美国妇产科学院的1000名妇产科成员，其中一半是协作门诊研究网络的成员。结果：在排除因素后，957名受访医师中有188名（19.6%）开启并回复了调查。年龄（31.9%）、体重指数（28.7%）和病史（27.1%）是妇产科医生拒绝为要求绝育的患者实施绝育手术的三个最常见原因。病史（36.2%）、胎次（31.9%）和可获得替代避孕方法（27.7%）是妇产科医生对未要求绝育的患者建议产后绝育的三个最常见原因。结论：我们的研究已经确定了影响妇产科医生推荐或反对产后绝育可能性的医学和非医学因素。非医疗因素包括临床后勤问题，如手术室的可用性，以及考虑患者的年龄、胎次、分娩时的胎龄，以及丈夫是否同意。医生应该小心不恰当地混合医疗决策与家长式的咨询。
Introduction: Obstetrician-gynecologists (ob-gyns) play a prominent role in counseling patients regarding sterilization, offering alternative contraception, fulfilling sterilization requests, and referring patients if unable to provide the service due to a personal moral belief. Therefore, we sought to better characterize the counseling practices of ob-gyns with respect to postpartum sterilization.Materials and methods: This is a prospective, electronic survey-based study of 1,000 ob-gyn members of the American College of Obstetricians and Gynecologists, half of whom are members of the Collaborative Ambulatory Research Network.Results: A total of 188 of 957 surveyed physicians (19.6%) opened and responded to the survey, after accounting for exclusions. Age (31.9%), body mass index (28.7%), and medical history (27.1%) were the three most frequent reasons for an ob-gyn reported declining to perform sterilization in a patient requesting sterilization. Medical history (36.2%), parity (31.9%), and availability of alternative contraception (27.7%) were the three most frequent reasons that an ob-gyn reported recommending postpartum sterilization in a patient not requesting sterilization.Conclusion: Our study has identified both medical and nonmedical factors that impact ob-gyns likelihood to recommend either toward or against postpartum sterilization. Nonmedical factors included clinical logistical issues such as availability of the operating room as well as considerations of a patient's age, parity, gestational age at delivery, and whether the husband was in agreement. Physicians should be cautious of inappropriately blending medical decision-making with paternalistic counseling.