Multi-dimensional Research On The Influence Of Maternal Delivery Decision From The Perspective Of Shared Decision Making

Purpose1.To understand the attitude and influencing factor to joint delivery decision making from medical staff,puerpera and family members through qualitative interview,to encourage the puerpera and family members to participate together in choosing the delivery mode,to select the most suitable delivery mode,and to reduce and prevent complications,and to improve the quality of life.2.To investigate the parturient participation in childbirth decision making through case control study,to explore the influencing factors to parturient delivery mode selection,to provide scientific basis to medical staff for the implementation of standardized and personalized health guidance,and to provide a basis for the smooth development of clinical decision-making.Method1.Using the phenomenological research method and qualitative research through purposive sampling,the author did a survey from May to October in 2018 on doctors and midwives who engaged in the work of maternity clinic in a first-class comprehensive hospital in Tianjin with semi-structured interview method.While in the same period,the author also interviewed in-hospital childbirth puerperae and their “puerpera-sitting” family members with semi-structured interview method.Based on the interview results,the author encoded and refined each interview's theme,and interprets interviewees' attitudes and influencing factors to joint participation in delivery mode decision.2.Case control study method was adopted to 154 selected cases of cesarean delivery from March to June 2018 in a first-class comprehensive hospital in Tianjin,while 154 cases of vaginal delivery in the same period were set as the control group.The differences in age,place of residence,education level,social support level and anxiety level were compared through a questionnaire survey.Logistic regression analysis was used to investigate the related factors of cesarean delivery.Result1.Through semi-structured interviews with 7 doctors,5 midwives,7 parturients and 6 parturients' family members,the results were obtained in two aspects:1.1 All the interviewees agreed that joint participation in the decision-making of delivery mode was conducive to the outcome of childbirth,and they held a supportive and positive attitude.Joint decision-making could enhance maternal confidence and sense of security,facilitate maternal cooperation in childbirth,benefit the health of the mother and the child,improve satisfaction,reduce medical disputes,and reflect the progress of medical system.1.2 Factors that could affect puerpera's participation in delivery mode decision are as follows: lack of clinical experience,job burnout,inadequate communication ability,unharmonious doctor-patient relationship,low doctor-patient mutual trust,lack of effective communication,and fear&concerns of vaginal delivery.Thus,a thorough cognition of delivery mode is conducive to puerpera's participation in delivery mode decision-making.Lack of effective medical information conversation between doctor and patient still exists.2.1 Chi square test was adopted to analyze single factor analysis,education degree,childbirth knowledge sources,occupation,mother-in-law and daughter-in-law relation.Independent sample t-test was used for analyzing puerpera's degree of social support and puerpera's perception degree of participation in decision-making.The results showed that puerperae who had bachelor's degrees or above,a variety of delivery information sources,sound relationship between mother-in-law and daughter-in-law,normal pregnancy body mass index,been pregnant twice below,no history of cesarean section,no fetal factors,estimated fetal size from 2500 g to 3999 g,normal pelvic measurements,no anxiety,high senses of participation and good social support preferred more to vaginal delivery.And those puerperae who were workers or company staff,and of whom the pre-pregnancy BMI?30,and had no history of vaginal delivery preferred more to cesarean delivery.2.2 Results of conditional Logistic regression analysis showed that the knowledge source of delivery(OR= 0.227),vaginal delivery history(OR=0.078),social support degree(OR=0.776)and patient perceived participation degree(OR=0.703)were the influencing factors for puerpera's preference for vaginal delivery.Cesarean section history(OR=51.180),fetal factors(OR=5.731),and pelvic measurement results(OR=21.342)were all influential factors for puerpera's preference for cesarean section.Conclusion1.The results from the semi-structured interview were obtained in two aspects,namely,the attitudes and benefits to the joint participation in childbirth decision-making,and the influencing factors to the joint participation in childbirth decision-making,so as to propose measures to promote the joint participation in decision-making,and to promote the smooth implementation of clinical joint decision-making.2.In view of the qualitative interviews on the influencing factors to joint decision in choosing childbirth method,proper intervention measures could be put forward.Through providing puerperae with high-level social support and effective delivery information,strengthening information communication,changing delivery mode,abandoning out-of-date thoughts,advocating scientific childbirth concepts,building safe medical environment,respecting the puerpera's will and sharing information on clinical decision-making,the target of promoting joint participation in deciding childbirth way.3.The following results were obtained through a questionnaire survey of 308 parturients: source of delivery knowledge(OR= 0.227),history of vaginal delivery(OR=0.078),degree of social support(OR=0.776)and the degree of patient's perceived participation(OR=0.703)were the influencing factors to parturients to choose vaginal delivery.Cesarean section history(OR=51.180),fetal factors(OR=5.731),and pelvic measurement results(OR=21.342)were all influenting factors to parturients' preferences for cesarean section.