Midwifery diagnosis of pregnancy or birth problems and assessment skill at the maternity home

本定性研究的目的是探讨助产士在日本关东地区一家妇产之家诊断妊娠或分娩问题和产妇护理评估方面的技能。我们采用了人种学方法，通过实地考察和对妇产科助产士的半结构化访谈收集数据；在2011年10月29日至2012年9月29日期间，我们共进行了7次数据收集。受试者是一名助产士和妇产科的经理，有50多年的临床经验；她在上世纪90年代创办了这家妇产之家。通常情况下，她每年要接生30个孩子。此外，她还使用超声波为孕妇进行检查。收集数据后，对现场观察笔记和访谈笔录进行阅读和主题分析编码，然后进行经验分类。主要研究结果如下：首先，助产士努力“更准确地评估预产期”，因为助产士无法在妇产院进行产前和产后分娩。其次，她试图“尽量减少超声波测量胎儿的错误”。第三，如果对怀孕日期的评估在超声波和月经计算之间存在差异，助产士会找出这种不一致的原因。最后，她向健康的准妈妈们解释了正常怀孕的常见方面和可能出现的问题，向她们保证她们正在经历一次正常的怀孕。她还解释说，健康的准妈妈通常会正常分娩，无论她们是初产还是多胞胎，而且每次分娩的持续时间和多胞胎分娩的周数是相似的。助产士在产院诊断和评估产妇护理的能力是基于她对基本产妇信息评估的准确性和检查的规律性。少

The purpose of this qualitative study was to explore midwives’ skills in diagnosing pregnancy or birth problems and maternal care assessment at a maternity home in the Kanto area of Japan. We used an ethnographic approach, collecting data through fieldwork observations and semi-structured interviews with a single midwife at a maternity home; in all, we conducted 7 data collection sessions between October 29,2011, and September 29, 2012. The subject was a midwife and manager of the maternity home with over 50 years of clinical experience; she had founded the maternity home in the 1990s. Typically, she manages about 30 deliveries per year. In addition, she performs check-ups for pregnant women using ultrasounds. After the data were collected, the observational field notes and transcriptions of interviews were read and coded using thematic analysis and then empirically categorized.The main findings were as follows. First, the midwife made efforts to “assess the expected date of confinemen … More t accurately,” because midwives are unable to perform pre- and post-term deliveries at maternity homes. Second, she attempted to “minimize errors in fetal measurement during ultrasound.” Third, if assessments of the date of conception differed between that suggested by the ultrasound and by menstruationcalculations, the midwife identified the reasons for this inconsistency. Finally, she assured healthy expecting mothers that they were undergoing a normal pregnancy, byexplaining the common aspects of normal pregnancies and problems that might arise. She also explained that healthy expecting mothers would typically have a normal delivery irrespective of them being primiparas or multiparas and that the duration of labor and week of delivery in multiparas would be similar for each of their deliveries. The midwife’s abilities to diagnose and assess maternal care at the maternity home were based on the accuracy of her assessments of basic maternity information and the regularity of check-ups. Less