助产士主导的咨询对经历过创伤性分娩的妇女的影响：一项临床试验

IF 2.6 3区医学 Q1 NURSING

Midwifery Pub Date : 2025-05-22 DOI:10.1016/j.midw.2025.104467

Simin Shaeri , Mouloud Agajani Delavar , Fatemeh Bakouei , Alireza Azizi , Maria Karbalaeizadeh

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引用次数: 0

摘要

背景：考虑到高创伤性分娩、创伤后应激、焦虑和抑郁，需要对医疗保健专业人员的咨询框架进行更多的研究。本研究旨在评估助产士主导的咨询对经历过创伤性分娩的妇女的影响。方法本研究采用伊玛目阿里医院于2023年6月至2024年1月进行的对照临床试验。96例符合条件的创伤性分娩妇女采用随机分组的方法分为产后助产咨询组（n=48）和对照组（n=48）两组。咨询组在产后72 h内接受标准的产后护理，并根据甘布尔模式进行面对面咨询，在产后第4周和第8周进行两次电话咨询。相反，对照组仅接受常规产后护理。妇女在产后期间的焦虑被评估为次要结果。采用IBM SPSS Statistics version 20进行统计学分析，显著性水平设为< 0.05。结果干预组和对照组在干预后12周的急性应激障碍（ASD）评分变化方面存在显著差异(-18.32；95% CI, -12.52 ~ -24.13；术中;0.001)。此外，在基于事件影响量表（IES-R）的创伤后应激障碍（PTSD）评分变化方面，两组之间存在显著差异(-14.49；95% CI, -11.63 ~ -17.34；术中;0.001)和检查表-民用（PCL） (-11.10；95% CI, -8.42 ~ -13.60；术中;0.001)，从基线到干预后。此外，从基线到干预后，焦虑评分的变化也有显著差异(-19.49；95% CI, -15.28 ~ -3.69；术中;0.001)。与对照组相比，咨询组在两种量表上患PTSD的相对风险（RR）都降低了60%以上。结论以助产士为主导的心理咨询能有效降低创伤性分娩后的心理困扰。它能改善ASD、PTSD症状和焦虑。将这种咨询纳入产后护理可以减轻PTSD的风险。较低的相对风险强调了其在促进产妇心理健康方面的潜力。未来的研究应该探索长期影响。

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Impact of midwife-led counseling for women who have experienced traumatic childbirth: A clinical trial

Background

Given high traumatic births, post-traumatic stress, anxiety, and depression, more research is needed for counseling frameworks for healthcare professionals. This study aims to assess midwife-led counseling impact on women who have experienced traumatic childbirth.

Method

This study employed a controlled clinical trial conducted at Imam Ali Hospital from June 2023 to January 2024. Ninety-six eligible women who had experienced traumatic childbirth were stratified into two groups, namely the postpartum midwifery counseling group (n=48) and the control group (n=48), utilizing random block allocation. The counseling group received standard postpartum care supplemented with face-to-face counseling based on the Gamble model within 72 h after childbirth, followed by two telephone counseling sessions in the fourth and eighth weeks post-delivery. Conversely, the control group received solely routine postpartum care. Women's anxiety during the postpartum period was assessed as a secondary outcome. Statistical analysis was conducted using IBM SPSS Statistics version 20, with a significance level set at less than 0.05.

Results

Significant differences were observed between the counseling and control groups regarding changes in Acute Stress Disorder (ASD) scores from baseline to 12 weeks post-intervention (-18.32; 95 % CI, -12.52 to -24.13; P< 0.001). Additionally, notable disparities were noted between the groups in terms of changes in Post-Traumatic Stress Disorder (PTSD) scores based on the Impact of Event Scale – Revised (IES-R) (-14.49; 95 % CI, -11.63 to -17.34; P< 0.001) and the CheckList – Civilian (PCL) (-11.10; 95 % CI, -8.42 to -13.60; P< 0.001) from baseline to post-intervention. Furthermore, a significant difference was observed in changes in anxiety scores from baseline to post-intervention (-19.49; 95 % CI, -15.28 to -3.69; P< 0.001). The relative risk (RR) of developing PTSD based on both scales was over 60 % lower in the counseling group compared to the control group.

Conclusion

In conclusion, this study shows midwife-led counseling effectively reduces psychological distress after traumatic childbirth. It improves ASD, PTSD symptoms, and anxiety. Integrating such counseling into postpartum care can mitigate PTSD risk. Lower relative risk underscores its potential in promoting maternal mental health. Future research should explore long-term effects.

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来源期刊

Midwifery 医学-护理

CiteScore

4.50

自引率

7.40%

发文量

221

审稿时长

13.4 weeks

期刊介绍： Midwifery publishes the latest peer reviewed international research to inform the safety, quality, outcomes and experiences of pregnancy, birth and maternity care for childbearing women, their babies and families. The journal’s publications support midwives and maternity care providers to explore and develop their knowledge, skills and attitudes informed by best available evidence. Midwifery provides an international, interdisciplinary forum for the publication, dissemination and discussion of advances in evidence, controversies and current research, and promotes continuing education through publication of systematic and other scholarly reviews and updates. Midwifery articles cover the cultural, clinical, psycho-social, sociological, epidemiological, education, managerial, workforce, organizational and technological areas of practice in preconception, maternal and infant care. The journal welcomes the highest quality scholarly research that employs rigorous methodology. Midwifery is a leading international journal in midwifery and maternal health with a current impact factor of 1.861 (© Thomson Reuters Journal Citation Reports 2016) and employs a double-blind peer review process.