【摘要】：目的:深入探討濱海新區(qū)剖宮產(chǎn)率的主要影響因素,為進(jìn)一步降低剖宮產(chǎn)率提供政策依據(jù)。方法:本研究通過定性與定量相結(jié)合的研究方法對(duì)2014年8月-2014年12月在第五中心醫(yī)院分娩的582名孕產(chǎn)婦進(jìn)行調(diào)查,在孕期各階段對(duì)剖宮產(chǎn)的認(rèn)知程度和其他相關(guān)因素進(jìn)行問卷調(diào)查,并采取對(duì)醫(yī)生護(hù)士等相關(guān)人員的深入訪談,對(duì)獲取資料進(jìn)行統(tǒng)計(jì)分析。結(jié)果:1.此次調(diào)查孕產(chǎn)婦的剖宮產(chǎn)率為55.67%(N=324),要比世界衛(wèi)生組織建議的10%一15%的水平高出4-5倍。2.影響孕產(chǎn)婦在懷孕的初期選擇哪種分娩方式的因素主要是孕產(chǎn)婦對(duì)剖宮產(chǎn)和順產(chǎn)的認(rèn)知程度有一定關(guān)系;影響孕產(chǎn)婦在分娩前選擇哪種分娩方式的因素主要是在懷孕期間產(chǎn)科檢查醫(yī)生、孕產(chǎn)婦的家長、丈夫及親朋好友、書本、報(bào)刊雜志對(duì)孕產(chǎn)婦選擇哪種分娩方式提出的一些建議;影響孕產(chǎn)婦在分娩的最后階段選擇哪種分娩方式的因素主要是孕產(chǎn)婦對(duì)自己生產(chǎn)的信心及產(chǎn)科醫(yī)護(hù)人員對(duì)孕產(chǎn)婦分娩方式的建議有非常密切的關(guān)系。3.最后通過采用多因素logistic回歸分析的方法,得出對(duì)孕產(chǎn)婦最終選擇哪種分娩方式的影響因素主要是以下幾種:孕產(chǎn)婦在最開始懷孕的時(shí)候選擇的分娩方式、產(chǎn)科檢查醫(yī)生對(duì)孕產(chǎn)婦分娩方式的建議、孕產(chǎn)婦家長丈夫及親朋好友的一些建議、孕產(chǎn)婦對(duì)自己生產(chǎn)的信心及在住院期間產(chǎn)科醫(yī)護(hù)人員對(duì)其分娩方式的建議等影響因素會(huì)影響孕產(chǎn)婦最終選擇分娩方式。以上的一些因素對(duì)孕產(chǎn)婦后選擇哪種分娩方式的影響是:1.孕產(chǎn)婦在開始懷孕的時(shí)候比較傾向于選擇剖宮產(chǎn)的,其最后選擇剖宮產(chǎn)分娩方式的比例要最高。2.產(chǎn)科檢查醫(yī)生對(duì)孕產(chǎn)婦提出建議其選擇剖宮產(chǎn)的,其最后選擇剖宮產(chǎn)分娩方式的比例要大于產(chǎn)科檢查醫(yī)生提出建議其選擇自然分娩方式的。結(jié)論:中國目前剖宮產(chǎn)率持續(xù)居于高位,其影響因素主要來自醫(yī)學(xué)的和社會(huì)的各方面原因,比如當(dāng)前突飛猛進(jìn)的剖宮產(chǎn)手術(shù)技術(shù)的發(fā)展、對(duì)于實(shí)施剖宮產(chǎn)手術(shù)指征的不恰當(dāng)?shù)倪M(jìn)行人為的擴(kuò)大、受家長丈夫及親朋好友的影響、孕產(chǎn)婦對(duì)于剖宮產(chǎn)手術(shù)片面的認(rèn)識(shí)及對(duì)自然分娩認(rèn)知的缺陷、各級(jí)醫(yī)療機(jī)構(gòu)產(chǎn)科醫(yī)務(wù)人員的助產(chǎn)技術(shù)水平不足、社會(huì)上的風(fēng)俗習(xí)慣和醫(yī)療衛(wèi)生體制法制建設(shè)的不完善。
[Abstract]:Objective: to explore the main influencing factors of cesarean section rate in Binhai New area and to provide policy basis for further reducing cesarean section rate. Methods: a total of 582 pregnant women who gave birth in the Fifth Central Hospital from August 2014 to December 2014 were investigated by qualitative and quantitative methods. The cognitive degree of cesarean section and other related factors were investigated by questionnaire in every stage of pregnancy, and the data were analyzed by in-depth interview with doctors and nurses. The result is 1: 1. The caesarean section rate in the survey was 55.67% (NJ324), 4-5 times higher than the 10% -15% level recommended by the World Health Organization. The main factors that affect the choice of delivery mode in the early pregnancy are the cognitive degree of cesarean section and natural delivery. The factors that influence the choice of delivery mode before delivery are the obstetrical examination doctor during pregnancy, the parents of pregnant women, husband and relatives and friends, books, newspapers and magazines, and some suggestions on which mode of delivery should be chosen by pregnant women; The factors influencing the choice of delivery mode in the final stage of delivery are the confidence of pregnant and lying-in women in their own delivery and the advice of obstetrics and health care workers on the mode of delivery of pregnant and lying-in women. Finally, by using the method of multivariate logistic regression analysis, it is concluded that the main factors influencing the final choice of delivery mode are the following: the mode of delivery that the pregnant women choose at the beginning of pregnancy, Obstetrical examiners' advice on how to give birth to pregnant women, and some advice from parents, husbands, relatives and friends of pregnant women, The influence factors such as maternal confidence in their own delivery and the advice of obstetrics and nurses on their delivery mode during hospitalization will influence the final choice of delivery mode for pregnant women. Some of the above factors on the maternal choice after the birth of the mode of birth is: 1. When pregnant women were more inclined to choose cesarean section at the beginning of pregnancy, the proportion of women who finally chose cesarean section was the highest. 2. The proportion of obstetrical examiners who give advice to pregnant women to choose cesarean section is larger than that of obstetrical examiners who suggest their choice of natural delivery mode. Conclusion: the rate of cesarean section in China continues to be high at present, and the influencing factors mainly come from various reasons of medicine and society, such as the rapid development of cesarean section technology. Under the influence of parents, husbands, relatives and friends, the pregnant and lying-in women have a one-sided understanding of cesarean section and defects in their cognition of natural delivery, because of the improper expansion of the indications of cesarean section, and due to the influence of parents, husbands, and relatives and friends. The technical level of midwifery in obstetrics and obstetrics of medical institutions at all levels is insufficient, and the customs and habits of society and the construction of medical and health system and legal system are not perfect.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R719.8

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