Nicholas Rubashkin, Brianna Bingham, Petra Baji, Imre Szebik, Sarolta Kremmer, Saraswathi Vedam
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After adjusting for social and clinical covariates, we used logistic regression to estimate the odds of obstetric procedures and disrespectful care and linear regression to estimate the level of autonomy (MADM scale).</p><p><strong>Findings: </strong>In the sample, 99 (7.8%) saw a community midwife for prenatal care. Those who planned community births had the lowest rates of cesarean at 9.1% (public: 30.4%; chosen doctor: 45.2%; chosen midwife 16.5%), induced labor at 7.1% (public: 23.1%; chosen doctor: 26.0%; chosen midwife: 19.4%), and episiotomy at 4.44% (public: 62.3%; chosen doctor: 66.2%; chosen midwife: 44.9%). Community birth clients reported the lowest rates of disrespectful care at 25.5% (public: 64.3%; chosen doctor: 44.3%; chosen midwife: 38.7%) and the highest average MADM score at 31.5 (public: 21.2; chosen doctor: 25.5; chosen midwife: 28.6). In regression analysis, community midwifery clients had significantly reduced odds of cesarean (0.35, 95% CI 0.16-0.79), induced labor (0.27, 95% CI 0.11-0.67), episiotomy (0.04, 95% CI 0.01-0.12), and disrespectful care (0.36, 95% CI 0.21-0.61), while also having significantly higher average MADM scores (5.71, 95% CI 4.08-7.36).</p><p><strong>Conclusions: </strong>Hungarian women who plan to give birth in the community have low obstetric procedure rates and report greater respect, in line with international data on the effects of place of birth and model of care on experiences of perinatal care.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345881/pdf/","citationCount":"0","resultStr":"{\"title\":\"In search of respect and continuity of care: Hungarian women's experiences with midwifery-led, community birth.\",\"authors\":\"Nicholas Rubashkin, Brianna Bingham, Petra Baji, Imre Szebik, Sarolta Kremmer, Saraswathi Vedam\",\"doi\":\"10.1111/birt.12818\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>To describe and compare intervention rates and experiences of respectful care when Hungarian women opt to give birth in the community.</p><p><strong>Methods: </strong>We conducted a cross-sectional online survey (N = 1257) in 2014. We calculated descriptive statistics comparing obstetric procedure rates, respectful care indicators, and autonomy (MADM scale) across four models of care (public insurance; chosen doctor or chosen midwife in the public system; private midwife-led community birth). We used an intention-to-treat approach. After adjusting for social and clinical covariates, we used logistic regression to estimate the odds of obstetric procedures and disrespectful care and linear regression to estimate the level of autonomy (MADM scale).</p><p><strong>Findings: </strong>In the sample, 99 (7.8%) saw a community midwife for prenatal care. Those who planned community births had the lowest rates of cesarean at 9.1% (public: 30.4%; chosen doctor: 45.2%; chosen midwife 16.5%), induced labor at 7.1% (public: 23.1%; chosen doctor: 26.0%; chosen midwife: 19.4%), and episiotomy at 4.44% (public: 62.3%; chosen doctor: 66.2%; chosen midwife: 44.9%). Community birth clients reported the lowest rates of disrespectful care at 25.5% (public: 64.3%; chosen doctor: 44.3%; chosen midwife: 38.7%) and the highest average MADM score at 31.5 (public: 21.2; chosen doctor: 25.5; chosen midwife: 28.6). 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引用次数: 0
摘要
引言描述并比较匈牙利妇女选择在社区分娩时的干预率和获得尊重护理的经历：我们于 2014 年进行了一项横断面在线调查（N = 1257）。我们计算了描述性统计，比较了四种护理模式（公共保险；在公共系统中选择医生或选择助产士；私人助产士主导的社区分娩）的产科手术率、尊重护理指标和自主性（MADM 量表）。我们采用了意向治疗法。在对社会和临床协变量进行调整后，我们使用逻辑回归估算了产科程序和不尊重护理的几率，并使用线性回归估算了自主程度（MADM 量表）：样本中有 99 人（7.8%）在社区助产士处接受产前护理。计划在社区分娩的产妇中，剖宫产率最低，为 9.1%（公立医院：30.4%；选择医生：45.2%；选择助产士：16.5%），引产率最低，为 7.1%（公立医院：23.1%；选择医生：26.0%；选择助产士：19.4%），外阴切开术率最低，为 4.44%（公立医院：62.3%；选择医生：66.2%；选择助产士：44.9%）。社区分娩客户报告的不尊重护理率最低，为 25.5%（公立医院：64.3%；选定医生：44.3%；选定助产士：38.7%），MADM 平均得分最高，为 31.5（公立医院：21.2；选定医生：25.5；选定助产士：28.6）。在回归分析中，社区助产士客户的剖宫产（0.35，95% CI 0.16-0.79）、引产（0.27，95% CI 0.11-0.67）、外阴切开术（0.04，95% CI 0.01-0.12）和不尊重护理（0.36，95% CI 0.21-0.61）几率明显降低，同时 MADM 平均得分也明显提高（5.71，95% CI 4.08-7.36）：结论：计划在社区分娩的匈牙利妇女的产科手术率较低，并表示受到了更多的尊重，这与有关分娩地点和护理模式对围产期护理体验的影响的国际数据一致。
In search of respect and continuity of care: Hungarian women's experiences with midwifery-led, community birth.
Introduction: To describe and compare intervention rates and experiences of respectful care when Hungarian women opt to give birth in the community.
Methods: We conducted a cross-sectional online survey (N = 1257) in 2014. We calculated descriptive statistics comparing obstetric procedure rates, respectful care indicators, and autonomy (MADM scale) across four models of care (public insurance; chosen doctor or chosen midwife in the public system; private midwife-led community birth). We used an intention-to-treat approach. After adjusting for social and clinical covariates, we used logistic regression to estimate the odds of obstetric procedures and disrespectful care and linear regression to estimate the level of autonomy (MADM scale).
Findings: In the sample, 99 (7.8%) saw a community midwife for prenatal care. Those who planned community births had the lowest rates of cesarean at 9.1% (public: 30.4%; chosen doctor: 45.2%; chosen midwife 16.5%), induced labor at 7.1% (public: 23.1%; chosen doctor: 26.0%; chosen midwife: 19.4%), and episiotomy at 4.44% (public: 62.3%; chosen doctor: 66.2%; chosen midwife: 44.9%). Community birth clients reported the lowest rates of disrespectful care at 25.5% (public: 64.3%; chosen doctor: 44.3%; chosen midwife: 38.7%) and the highest average MADM score at 31.5 (public: 21.2; chosen doctor: 25.5; chosen midwife: 28.6). In regression analysis, community midwifery clients had significantly reduced odds of cesarean (0.35, 95% CI 0.16-0.79), induced labor (0.27, 95% CI 0.11-0.67), episiotomy (0.04, 95% CI 0.01-0.12), and disrespectful care (0.36, 95% CI 0.21-0.61), while also having significantly higher average MADM scores (5.71, 95% CI 4.08-7.36).
Conclusions: Hungarian women who plan to give birth in the community have low obstetric procedure rates and report greater respect, in line with international data on the effects of place of birth and model of care on experiences of perinatal care.
期刊介绍：
Birth: Issues in Perinatal Care is a multidisciplinary, refereed journal devoted to issues and practices in the care of childbearing women, infants, and families. It is written by and for professionals in maternal and neonatal health, nurses, midwives, physicians, public health workers, doulas, social scientists, childbirth educators, lactation counselors, epidemiologists, and other health caregivers and policymakers in perinatal care.
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