| Objective:In order to understand the demand status of pregnant women with second pregnancy after cesarean section,to construct a continuum of midwifery management model centred on maternal needs,and to explore the influence of a continuum of midwifery management model centred on maternal needs on the delivery outcome,psychological state,weight management and self-efficacy of pregnant women with second pregnancy after cesarean section,so as to provide reference for the standardized management of pregnant women with previous cesarean section under the background of fertility reform,in order to reduce the rate of cesarean section and promote natural childbirth.Methods:1Questionnaire survey: 228 pregnant women with second pregnancy after cesarean section were selected by convenience sampling method in a tertiary hospital of Lanzhou city.The self-made questionnaire "questionnaire on perinatal cognition and needs of pregnant women with second pregnancy after cesarean section" was used to understand the needs of pregnant women with second pregnancy after cesarean section.2Plan formulation: Based on the questionnaire survey to understand the needs of pregnant women,combined with the literature and actual clinical practice,the midwifery management team initially developed the continuous midwifery management program based on the needs of pregnant women,and then invited experts with rich experience in perinatal center,obstetrics,midwives,nutrition analysis and other related fields to conduct group discussion,and finally developed the continuous midwifery management program based on the needs of pregnant women.3 Effect evaluation: 160 pregnant women with second pregnancy after cesarean section in a tertiary hospital in Lanzhou were randomly divided into experimental group(80 cases)and control group(80 cases)by random number table.The control group was given routine obstetric management mode,and the experimental group was given continuous midwifery management mode centered on the needs of pregnant women.The effect was evaluated by PWMSS,CAQ,PAQ and CBSEI-C32 before and 24 hours after delivery,and the delivery outcomes of the two groups were compared.Results:I: Survey results1 Cognition of delivery plan: only 50.4% of 222 pregnant women thought that vaginal delivery could be performed after cesarean section,47.3% of them would choose vaginal trial delivery;46.4%want to have a health management plan jointly made by doctors,midwives and themselves(69.9%)in obstetric outpatient departmen(81.6%)t;the majority of the patients who chose midwives tended to recommend by doctors(37.3%).2 Knowledge needs: the most important concerns of this pregnancy are fetal health(25%),postnatal recovery(13.3%)and delivery mode(12.6%).Most of them want to have personalized delivery plan(29.7%),Prenatal intrapartum postpartum continuous service(26.1%),explain the knowledge of pregnancy after cesarean section(17.4%),and the most ideal ways to acquire knowledge were network platforms such as We Chat and Douyin(31.6%),mobile app(18.0%)and one-to-one explanation(16.2%).3 Evaluation results:(1)Overall service demand: the highest demand was postpartum service and the lowest was intrapartum service.The top five service items were neonatal vaccination,neonatal care,admission guidance,prenatal examination guidance and puerperium guidance.(2)Service demands in different periods: admission guidance,prenatal examination guidance and pain relief methods were the highest demands for prenatal service,while visiting the delivery center and simulating the delivery experience score was the lowest;privacy protection during labor,guidance on delivery skills and guidance on labor pain during labor were the highest demands for intrapartum service,while massage lumbosacral and back during uterine contraction and perineum during the second stage of labor The score of massage was the lowest;the highest demand of postpartum service were neonatal vaccination,neonatal care and puerperal guidance,while the lowest score of postpartum psychological adjustment,postpartum sexual life and contraception.4 Differential analysis of perinatal services: different education level,occupation and family monthly income had differences in perinatal demand(P < 0.05),but different age,gestational age,number of pregnancies,number of births,interval time,natural childbirth and vaginal trial production had no differences in perinatal demand(P > 0.05).5 Correlation analysis: there was a negative correlation between vaginal trial delivery in this pregnancy and vaginal delivery in the previous cesarean section(-0.170);There was a significant and negative correlation between the intention to make a pregnancy management plan and the family monthly income(-0.224).Ⅱ: evaluation of intervention effect1 Effect on pregnancy anxiety and childbirth fear: before intervention,there was no significant difference in PAQ score,CAQ score,number of anxiety and fear degree between the two groups(P > 0.05).After the continuous midwifery management mode centered on the needs of pregnant women,the score,number of anxiety and fear degree of the experimental group were significantly lower than those of the control group(P < 0.05).2 Effect on self delivery efficacy: before intervention,there was no significant difference in CBSEI-C32,OE-16 and EE-16 scores between the two groups(P > 0.05).After the continuous midwifery management mode centered on the needs of pregnant women,the score of the experimental group increased significantly(P < 0.05),and was significantly higher than that of the control group(P < 0.05).3 Effect on weight management: before the intervention,there was no significant difference in PWMSS score between the two groups(P > 0.05).After the continuous midwifery management mode centered on the needs of pregnant women,the score of the experimental group increased significantly(P < 0.05),and was significantly higher than that of the control group(P < 0.05).4 Outcome of delivery: the rate of cesarean section,length of stay,hospitalization cost and postpartum anemia in the experimental group were significantly lower than those in the control group(P<0.05),while the incidence of postpartum 2h blood loss,neonatal weight,gestational diabetes mellitus,gestational hypertension,macrosomia and postpartum infection were lower than those in the control group,but there was no statistical difference(P>0.05).Conclusion:1 The pregnant women didn’t know the delivery way about the second pregnancy after cesarean section,the methods to relieve labor pain and new appropriate midwifery technology,had weak awareness of health management during pregnancy,and had weak intention to choose the midwife clinic;they hope to have more convenient access to personalized and continuous midwifery services,and the demand for postpartum service is the highest,and the needs of pregnant women with different demographic data are also different;they pay more attention to the health of newborns than themselves,and the intention of delivery is related to whether the previous cesarean section is vaginal trial delivery or not.2 The continuous midwifery management mode centered on the needs of pregnant women can reduce pregnancy anxiety and fear of delivery,improve self-efficacy of delivery and the use of weight management strategy during pregnancy,improve the natural delivery rate,reduce the rate of repeated cesarean section,shorten the length of hospital stay,reduce the cost of hospitalization,reduce the occurrence of postpartum anemia,and improve the delivery outcome. |
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