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

本质性研究的目的是探讨助产士在诊断怀孕或分娩问题和产妇护理评估在日本关东地区的一个产院的技能。我们采用人种学方法，通过实地观察和半结构化访谈收集数据，其中一名助产士在妇产科之家;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。研究对象是一名助产士和妇产院经理，拥有50多年的临床经验;她于1990年代创办了妇产院。通常情况下，她每年管理大约30次交付。此外，她还使用超声波为孕妇进行检查。在收集资料后，本研究以主位分析的方式，阅读观察性田野笔记与访谈记录，并进行编码，然后进行实证分类，主要发现如下。首先，助产士努力“评估预产期 ...更多信息 因为助产士无法在妇产医院进行产前和产后分娩。第二，她试图“尽量减少超声测量胎儿时的误差”。第三，如果超声波和怀孕计算得出的受孕日期不同，助产士会找出不一致的原因。最后，她通过解释正常怀孕的常见方面和可能出现的问题，向健康的准妈妈保证她们正在经历正常怀孕。她还解释说，健康的准妈妈通常会有一个正常的分娩，无论他们是双胞胎或多胞胎，并在多胞胎分娩的持续时间和分娩周将是相似的，为他们的每一个交付。助产士在产院诊断和评估产妇护理的能力取决于她对产妇基本信息评估的准确性和检查的定期性。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