周金英 孙杨芳 陈红 叶俊花

[摘要] 目的 探討导乐师、助产士、产妇家属共同参与的组合导乐陪伴分娩模式（“2+1”导乐陪伴分娩模式）对初产妇产程时间、心理状态及母婴结局的影响。 方法 选取2019年9—12月我院产科门诊建档并规律产检符合自然分娩指征的初产妇120例为研究对象，按照随机数字表法将其中60例接受“2+1”组合导乐陪伴分娩的产妇设为观察组，另外60例接受常规的产科服务模式的产妇设为对照组。记录比较两组孕产妇自然分娩率及围产期焦虑状况;比较两组经阴道分娩产妇产程时间、分娩疼痛VAS评分、产后2 h出血量、新生儿Apgar评分。 结果 观察组产妇自然分娩率为96.67%，明显高于对照组的86.67%，差异有统计学意义（P<0.05）;观察组产妇宫口开大3 cm时、产后2 h SAS评分明显低于对照组，差异有统计学意义（P<0.05）;观察组产程（第一、第二产程）时间明显短于对照组，观察组分娩疼痛评分、产后2 h出血量均低于对照组，差异有统计学意义（P<0.05），观察组新生儿Apgar 评分为（9.76±0.85）分，明显高于对照组的（8.91±0.82）分，差异有统计学意义（P<0.05）。 结论 “2+1”组合陪伴式分娩模式能够提高产妇阴道分娩率，缩短产程时间，减轻分娩疼痛和焦虑情绪，提高助产服务质量，保障母婴安全。

[关键词] “2+1”组合导乐陪伴分娩模式;初产妇;产程时间;心理状态;母婴结局

[中图分类号] R473.71          [文献标识码] B          [文章编号] 1673-9701（2021）08-0172-04

The effect of“2+1” combined Doula accompany delivery mode on primipara′s delivery time， mental state， and maternal and infant outcome

ZHOU Jinying   SUN Yangfang   CHEN Hong   YE Junhua

Department of Obstetrics， Hangzhou Obstetrics and Gynecology Hospital， Hangzhou   310009， China

[Abstract] Objective To explore the effect of the combined Doula accompany delivery mode （“2+1” Doula accompany delivery mode） with the participation of Doula， midwives， and maternal family members on the time of delivery， psychological status， and maternal and infant outcome of primiparas. Methods A total of 120 cases of primiparas who were filed in our hospital's obstetric outpatient clinic from September 2019 to December 2019 and had regular obstetric examinations in line with the indications for natural delivery were selected as the research objects. According to the random number table method， 60 cases who gave birth with the “2+1” combined Doula accompany were included in the observation group， and the other 60 cases who received routine obstetric services were included in the control group. The natural childbirth rate and perinatal anxiety between the two groups were recorded and compared. The labor time， pain during labor， the amount of bleeding during the 2 h postpartum period， and the Apgar score of the newborn were compared between the two groups. Results The maternal natural delivery rate was 96.67% in the observation group was higher than that of （86.67%） in the control group， and the difference was statistically significant （P<0.05）. The anxiety score in the observation group was significantly lower than that in the control group when the uterine orifice was 3 cm wide and at 2 hours postpartum ， and the difference was statistically significant（P<0.05）. The time of labor （first and second stages of labor）， labor pain score， and 2 h postpartum hemorrhage in the observation group were lower than those in the control group ， and the difference was statistically significant（P<0.05）. The newborn Apgar score in the observation group was （9.76±0.85） points， which was higher than that of （8.91±0.82） points in the control group， and the difference was significant （P<0.05）. Conclusion The "2+1" combined accompany delivery mode can increase the vaginal delivery rate， shorten the delivery time， reduce the pain and anxiety of delivery， improve the quality of midwifery services， and ensure the safety of mothers and babies.

[Key words] "2+1" combined Doula accompany delivery mode; Primipara; Delivery time; Mental state; Maternal and infant outcome

分娩是一个自然的生理过程，但作为一种持久而强烈的应激源，会给产妇带来复杂的生理和心理反应[1]。产妇在分娩过程中会感到焦虑、恐惧、疼痛和孤独，这些负性情绪可导致子宫收缩力减弱，产程延长，对产妇及胎儿均有不利影响。在产妇整个分娩过程中，给予生理、心理等方面的支持，提高其自然分娩的信心，对于改善母婴分娩结局具有重要意义[2]。研究[3]表明，大多数初产妇对家属陪伴的渴望超过对助产士的渴望，希望配偶看到自己分娩的疼痛与辛苦，从而促进夫妻亲密关系，且家属可以作为自己和医护人员之间的信息传递者。……