A Study of the Factors Influencing Women's Decision about Childbirth

简介（由申请人提供）：摘要剖宫产术（CS）目前的使用率是世界卫生组织建议的两倍多（CDC, 2006）；在过去的二十年中，由于一些尚未被充分理解的原因，该手术的使用几乎翻了一番。过度使用导致本可避免的发病率和死亡率以及与分娩有关的更高保健费用。人们提出了许多增加使用CS的原因，包括“产妇请求”数量的增加，即健康妇女在没有医学指征的情况下要求CS。美国国立卫生研究院的一个专家小组探讨了产妇的要求，得出的结论是，目前没有足够的证据证明在没有医学指征的情况下对产妇的要求采取CS，并建议“加强研究，致力于预测和影响阴道分娩成功可能性的策略”（美国国立卫生研究院，2006年，第20页）。根据同样的数据，美国妇产科学会（ACOG）得出结论，只要健康的母亲知情，就没有理由拒绝手术分娩（ACOG， 2003年）。这些立场之间的分歧表明，在了解推动避孕率的因素方面存在重大差距，包括孕产妇需求对避孕使用的影响。尽管最近关注的是产妇的需求，但很少有研究表明女性想从分娩经历中得到什么，包括她们选择一种分娩方式而不是另一种分娩方式的原因。我们提出研究的目的是为了回答这个问题：什么因素会影响女性对孩子出生方式的决定？女性对第一次生育经历的希望和渴望受到她们所知道的东西的影响——无论是有意识的还是无意识的。因为人们只是部分意识到告知他们的希望和愿望的态度和信念，本提案将使用三种数据收集方法。第一种是投射法，通常用于社会科学中获取存在于意识之外的知识。第二种是焦点小组方法，它为分娩妇女提供了一个场所，让她们清楚地表达自己对分娩的有意识基础，并允许参与者将自己的想法与他人进行比较。第三，在孩子出生后，所有的女性都将接受采访，以了解她们的经历如何影响女性未来的生育选择。参与者将是50名年龄在21岁或以上的无并发症怀孕的初产妇。这一建议建立在研究人员之前与CS使用相关的工作基础上。这是一个明确的研究方案中的一个步骤，该方案旨在通过优化怀孕、分娩和分娩期间的护理来改善母亲及其子女的健康。公共卫生相关性：该项目的重点是建立关于妇女希望从分娩经验中得到什么以及是什么影响了她们对分娩方式的选择的知识。如果我们要了解产妇需求在CS使用中的作用，这一知识是必不可少的。我们的数据将为公共卫生政策提供信息，这些政策既支持孕产妇选择，又通过减少与分娩相关的风险来确保母婴长期健康。这项研究是一个致力于改善妇女健康和对分娩体验满意度的系统研究项目的一部分。

DESCRIPTION (provided by applicant): Abstract Cesarean section (CS) is currently used at over twice the rate recommended by the World Health Organization (CDC, 2006); use of the procedure has almost doubled in the last two decades for reasons that are as yet poorly understood. Overutilization results in avoidable morbidity and mortality and higher health costs related to childbirth. Many causes for the increased use of CS have been suggested, including growth in the number of "maternal requests" -- healthy women asking for CS in the absence of medical indications. An NIH expert panel explored maternal request CS and concluded that at this time there is insufficient evidence to warrant CS on maternal demand without medical indications and recommended "increased research devoted to strategies to predict and influence the likelihood of successful vaginal birth" (NIH, 2006, p. 20). Using the same data, the American College of Obstetrics and Gynecologists (ACOG) concluded that there is no reason to deny a surgical birth to a healthy mother as long as she is well-informed (ACOG, 2003). The divergence between these positions points to a critical gap in knowledge about the factors that drive CS rates, including the influence of maternal demand on the use of CS. Despite this recent focus on maternal demand, there is scant research on what women want from their birthing experience, including their reasons for choosing one mode of childbirth over another. The purpose of our proposed research is to answer the question: what factors influence women's decisions about how their babies will be born? Women's hopes and desires for their first birth experience are influenced by what they know - both consciously and unconsciously. Because people are only partly aware of the attitudes and beliefs that inform their hopes and desires, this proposal will use three methods of data collection. The first is a projective method commonly used in the social sciences to access knowledge that exists outside of consciousness. The second is a focus group method that provides a venue for birthing women to articulate the conscious basis for their ideas about childbirth and allow participants to compare their ideas with others. Third, all women will be interviewed after the baby is born to build understanding about how their experiences influence future birthing choices the women make. Participants will be 50 primigravid women with uncomplicated pregnancies aged 21 or older. This proposal builds on the researchers' previous work related to the use of CS. It is one step in a defined program of research directed towards improving the health of mothers and their children by optimizing care during pregnancy, labor and birth. PUBLIC HEALTH RELEVANCE: This project in focused on building knowledge about what women want from their birthing experience and what informs their choices about mode of birth. This knowledge is essential if we are to understand the role of maternal demand in use of CS. Our data will inform public health policy concerned with both supporting maternal choice and ensuring long term maternal- child health by reducing the risks associated with childbirth. This study is part of a systematic program of research dedicated to improving women's health and satisfaction with their birthing experience.