POSTPARTUM PERMANENT CONTRACEPTIVE PROCEDURES: A 360-DEGREE QUALITATIVE INVESTIGATION

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception Pub Date : 2024-10-07 DOI:10.1016/j.contraception.2024.110628

K Crofton, A Johnston, S Kaszubinski, S Betstadt, E Tal, R Flink-Bochacki

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引用次数: 0

Abstract

Objectives

We aimed to explore interdisciplinary factors affecting completion of postpartum permanent contraceptive procedures after vaginal delivery.

Methods

We conducted a multi-center qualitative study on completion or non-completion of postpartum permanent contraceptive procedures at three academic institutions from July 2023-March 2024. We recruited postpartum patients who desired permanent contraceptive procedures following vaginal delivery. We conducted semi-structured interviews with patients and their nursing, obstetric, and anesthesia teams. We double-coded transcripts using Dedoose and performed inductive thematic content analysis, concluding data collection after thematic saturation.

Results

We interviewed 19 patients (11 completed and 9 non-completed procedures) and 47 staff (mean 2.5/patient). We identified three major themes: (1) Standard perioperative counseling can be overshadowed by a focus on overcoming obstacles to completion (“What did [your doctors] tell you to expect?” “Really nothing, they just asked if I was sure I want it…”); (2) Healthcare workers’ personal values influence the prioritization of these procedures (“I believe that some are elective and some are more urgent”); (3) Procedure completion often relies on one champion to optimize interdisciplinary communication and push past barriers (“We could not get a slot for her on day 1…and then we did on day 2, mostly because [attending] advocated for her”).

Conclusions

Unlike most surgeries, the completion of postpartum permanent contraceptive procedures centers around overcoming barriers to access rather than patient needs. The propensity for clinician advocacy to detract from perioperative patient care is a novel finding, and it sustains a culture where contraceptive requests are actualized based on care-team factors rather than patient factors.

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产后永久避孕程序：360 度定性调查

目的我们旨在探讨影响阴道分娩后完成产后永久避孕手术的跨学科因素。方法我们于 2023 年 7 月至 2024 年 3 月在三所学术机构开展了一项关于产后永久避孕手术完成或未完成情况的多中心定性研究。我们招募了希望在阴道分娩后接受永久避孕手术的产后患者。我们对患者及其护理、产科和麻醉团队进行了半结构化访谈。我们使用 Dedoose 对记录誊本进行了双重编码，并进行了归纳式主题内容分析，在主题饱和后结束了数据收集。我们确定了三大主题：(1) 标准的围手术期咨询可能会被对克服手术完成障碍的关注所掩盖（"（医生）告诉你要注意些什么？"真的没什么，他们只是问我是否确定要做......"）；（2）医护人员的个人价值观影响了这些手术的优先顺序（"我认为有些是选择性的，而有些则更紧急"）；（3）手术的完成往往依赖于一位倡导者来优化跨学科沟通并克服障碍（"我们在第一天没能为她争取到一个名额......然后我们在第二天争取到了，主要是因为[主治医生]为她做了宣传"）。结论与大多数手术不同，产后永久性避孕手术的完成主要围绕克服获得手术机会的障碍，而不是病人的需求。临床医生的宣传倾向会影响围手术期的患者护理，这是一个新的发现，它维持了一种文化，即避孕要求的实现是基于护理团队的因素而非患者的因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Contraception 医学-妇产科学

CiteScore

4.70

自引率

17.20%

发文量

211

审稿时长

69 days

期刊介绍： Contraception has an open access mirror journal Contraception: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal Contraception wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion. The journal welcomes manuscripts from investigators working in the laboratory, clinical and social sciences, as well as public health and health professions education.