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目的了解湖南省实施自然分娩健康促进干预后婴儿母亲分娩意愿、方式等结局的变化,为进一步完善促进自然分娩的干预措施提供依据。方法本研究为干预前后自身对照研究,分别于2012年7—8月和2015年7—8月,采用两阶段分层整群随机抽样方法,在湖南省6所医院对603名和588名分娩的妇女进行问卷调查。结果基线(干预前)共调查婴儿母亲603人,分娩意愿为自然分娩的共396人(65.67%),剖宫产207人(34.33%);终末(干预后)调查中婴儿母亲588人,自愿选择自然分娩的共426人(74.30%),剖宫产147人(25.70%);干预前后比较差异有统计学意义(χ~2=10.383,P=0.001)。三级医院中,县级医院干预后婴儿母亲自己希望自然分娩的比例提高明显(χ~2=13.325,P<0.001)。实施干预前后婴儿母亲分娩意愿为剖宫产的最主要原因分别为产前检查发现异常情况(39.30%)和以前有剖宫产史(44.10%)。干预后选择自然分娩的比例明显提高(χ~2=6.098,P=0.014)。结论湖南省自然分娩健康促进干预对婴儿母亲分娩意愿选择具有影响,干预后自愿选择自然分娩的比例增加,有剖宫产意愿的比例降低,使待产的婴儿母亲增加了自然分娩的信心,减轻临产和分娩的恐惧感,且对医生和医院更加信任。
Objective To understand the changes of the mothers’ wishes and methods of childbirth after the intervention of natural childbirth in Hunan Province, so as to provide the basis for further improving the interventions for promoting natural childbirth. Methods This study was a self-control study before and after intervention. From July to August in 2012 and July to August in 2015, two-stage stratified cluster random sampling method was used in 603 hospitals and 588 labor-delivery centers in 6 hospitals in Hunan Province Women conduct questionnaires. RESULTS: A total of 603 infants were investigated at the baseline (intervention level). 396 (65.67%) were willing to give birth and 207 were cesarean (34.33%). 588 were mothers in the terminal (post-intervention) A total of 426 people (74.30%) volunteered for natural childbirth and 147 people (25.70%) for cesarean section. The difference was statistically significant before and after intervention (χ ~ 2 = 10.383, P = 0.001). In tertiary hospitals, the percentage of spontaneous deliveries that mothers themselves would like their babies to raise spontaneously after county hospital intervention was significantly higher (χ ~ 2 = 13.325, P <0.001). The main causes of cesarean delivery before and after the intervention were the abnormalities of prenatal examination (39.30%) and the previous cesarean section (44.10%). After intervention, the proportion of patients choosing natural childbirth increased significantly (χ ~ 2 = 6.098, P = 0.014). Conclusions The intervention of health promotion of natural childbirth in Hunan Province has an impact on the choice of childbirth mothers. After the intervention, the proportion of spontaneous childbirth in voluntary choice increases and the proportion of cesarean delivery intention decreases. This will increase the confidence of the childbearing mother in natural childbirth and reduce the labor force And the fear of childbirth, and more trust for doctors and hospitals.