产妇护理中虐待的发生率：基于人群的综合多指标方法

IF 2.6 3区医学 Q1 NURSING

Midwifery Pub Date : 2025-06-13 DOI:10.1016/j.midw.2025.104493

Z. Reyes-Amargant , M. Roqueta-Vall-Llosera , J. Garre-Olmo , D. Ballester-Ferrando , C. Rascón-Hernán , C. Fuentes-Pumarola

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引用次数: 0

摘要

背景：产科文献缺乏对什么构成虐待产妇护理（MMC）的明确。这包括非人性化的护理、过度干预和将自然过程医疗化。目的通过制定多来源指标来估计MMC的患病率，并确定其与社会人口统计学和分娩特征的关系。方法采用观察性、横断面多中心研究，连续招募978名受试者。从自我填写的问卷和登记在临床记录中的现有信息中收集产科实践。研究结果9 MMC指标（MMCi）是根据循证实践制定的。847名妇女接受参加（87.9%）。未在临床记录中登记或有非循证临床指征（UNREG/N-EB）的器械分娩或剖宫产的MMCi患病率为4.3% (95% CI = 3.1 - 6.1)，感知注意不足的MMCi患病率为48.1% （95% CI = 45.1 - 52.2）。6项指标在40%以上（未经书面同意引产、常规羊膜切开、推产中取石、母婴分离、产中无产妇体位选择、随意饮水）。私人设施与使用UNREG/N-EB做法有关。分娩特征与MMCi表现出不同的相关性。结论本研究突出了尊重分娩护理的推荐标准与实际临床实践之间的差距。解决MMC问题需要一种综合的方法，包括临床数据和妇女的看法，以及执行良好的临床实践政策。未来的研究应侧重于交叉因素和减少差异，以确保所有妇女获得公平、高质量的护理。

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Prevalence of mistreatment in maternity care: a population-based comprehensive multi-indicator approach

Background

Obstetric literature lacks clarity on what constitutes Mistreatment in Maternity Care (MMC). This includes dehumanized care, excessive interventions, and medicalization of a natural process.

Aims

To estimate the prevalence of MMC by developing multiple-source indicators and to determine their relationship with sociodemographic and childbirth characteristics.

Methods

Observational and cross-sectional multicentric study with 978 participants contacted by consecutive recruitment. Obstetric practices were collected from self-administered questionnaires and the available information registered in clinical records.

Findings

9 MMC indicators (MMCi) were developed according to evidence-based practice. 847 women accepted to participate (87.9 % participation). The prevalence of MMCi was 4.3 % (95 % CI = 3.1 –6.1) for instrumental delivery or caesarean unregistered in clinical records or performed with non-evidence-based clinical indication (UNREG/N-EB), and 48.1 % (95 % CI = 45.1– 52.2) for perception of inadequate attention. Six indicators were above 40 % (induction without a written consent, amniotomy performed as routine, lithotomy during pushing, suffering mother-baby separation, no maternal position choice during labor and delivery, or to drink freely). Private facilities were associated with the use of UNREG/N-EB practices. Childbirth characteristics showed differential associations with MMCi.

Conclusions

This study highlights the gap between recommended standards for respectful childbirth care and actual clinical practices. Addressing MMC requires a comprehensive approach that includes both clinical data and women’s perceptions, along with the enforcement of good clinical practice policies. Future research should focus on intersectional factors and reducing disparities to ensure equitable, high-quality care for all women.

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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.