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目的:比较非医学因素剖宫产产妇和正常阴道分娩产妇认知行为特点,寻找降低剖宫产率、提高产科质量的措施。方法:自行设计调查问卷,对无医学指征剖宫产产妇(研究组)和正常阴道分娩产妇(对照组)各220例进行认知行为调查,比较两组对剖宫产和阴道分娩相关认识的16个单变量差异,多变量分析建立非条件Logistic回归主效应模型。结果:①研究组城市居民、脑力劳动、高收入家庭比例高于对照组(P<0.01);②单因素分析显示,剖宫产产妇更关注剖宫产手术对母儿安全、形体美、孩子聪明、吉利,惧怕阴道分娩痛苦和产后阴道松弛影响性生活;对照组更关注阴道分娩费用低、是自然生理过程、产后恢复快等;两组在孕期剖宫产意向、阴道分娩信心不足、听从医生、家属、朋友、中介媒体分娩方式建议和剖宫产可以达到“完美分娩”等认知方面存在显著差异;③多因素分析显示:剖宫产分娩结局更“完美”、阴道产会影响日后性生活、孕期剖宫产行为意向、医生对分娩方式的建议、阴道产属自然生理过程等5个因素对孕妇选择剖宫产有显著影响,其中阴道产属自然生理过程为保护因素。结论:认知行为偏差是导致无剖宫产医学指征孕妇选择剖宫产的重要原因。加强分娩方式的宣传和教育,理性认知剖宫产的利弊是降低剖宫产率、提高产科质量的关键。
OBJECTIVE: To compare the cognitive behaviors of non-medical caesarean women and normal vaginal delivery women in order to find ways to reduce the rate of cesarean section and improve the quality of obstetrics. Methods: A questionnaire was designed by ourselves to investigate the cognitive behavior of 220 pregnant women (study group) and normal vaginal delivery women (control group) without medical indications. The cognition of caesarean section and vaginal delivery were compared between the two groups Of 16 univariate differences, multivariate analysis of the establishment of non-conditional Logistic regression main effect model. Results: ① The proportion of urban residents, mental workers and high-income families in the study group was higher than that in the control group (P <0.01). (2) Univariate analysis showed that cesarean section was more concerned with the safety of cesarean section, physical beauty, Clever, auspicious, fear of painful vaginal delivery and postpartum vaginal relaxation affect life; the control group is more concerned about the low cost of vaginal delivery is a natural physiological process, rapid postpartum recovery; cesarean section intention during pregnancy, vaginal delivery lack of confidence, There was a significant difference in the cognition of doctors, family members, friends and intermediaries, cesarean section and cesarean section. The multivariate analysis showed that cesarean section had a more “perfect” childbirth end result, vaginal Production will affect the future life, cesarean section during pregnancy intention, the doctor’s advice on the mode of delivery, vaginal natural physiological processes and other five factors on the choice of pregnant women have a significant effect on cesarean section, of which the vagina is a natural physiological process for the protection factor. CONCLUSION: Cognitive behavioral biases are the important reasons for cesarean section in pregnant women without medical indication of cesarean section. Strengthen the propaganda and education mode of delivery, rationally recognize the pros and cons of cesarean section is to reduce the rate of cesarean section, improve the quality of obstetrics the key.