The Construction And Application Of Birth Plan Based On Continuous Partnership

【Objective】Based on forming a rigorous and scientific template of the birth plan,this research aimed to analyze and identify the needs of pregnant women guided by the Iceberg Theory,established partnership with pregnant women and implemented the personal birth plan to meet the personal needs of the women.It was also aimed to discuss the influence of birth plan based on the partnership on the delivery outcomes,pregnant women’s anxiety degree and childbirth service satisfaction.【Methods】1.Construction of content template of birth plan.On the basis of consulting the clinical guide、literature review and group discussion,the preliminary index system was designed,include 8 first level index、31 secondary indicators and 98 three indicators.Through the the method of expert consultation,15 experts who work in obstetrics medical treatment,nursing,midwifery and teaching were consulted by questionnaire in two rounds to determine the contents of the content template of childbirth plan.On this basis,a preliminary test was carried out to further revise and adjust the indicators of the formed template of birth plan,and finally finished the content template of the birth plan for application in this study.2.The application of birth plan based on continuous partnership.90 healthy primiparas who had established an archive in the Obstetrics Department of a comprehensive first-class hospital and received regular antenatal examinations from February 2019 to September 2019 were selected as the objects of research.The objects of research were divided into the intervention group and control group with45 cases respectively in each group by adopting the random number table method.The control group received antenatal examinations,delivery in the delivery room and other routine maternity care services.Based on the routine antenatal services,women in the intervention group,established a continuous partnership with the researcher from the 28^th gestational week（±3 days）to the end of delivery through face-to-face communication,antenatal examination accompanying,communication on We Chat,telephone communication and other methods;the connotation of the Iceberg Theory was combined to formulate the birth plan.The delivery duration,amount of bleeding in the first 2 hours after delivery,rate of episiotomy,the usage rate of oxytocin,total Caesarean section rate,rate of non-medically indicated Caesarean section,Apgar score of newborns,transfer rate,pregnant women’s anxiety degree and delivery service satisfaction of cases in the two groups were compared.【Results】1.Experts’advice and preliminary test results.We have successfully consulted 15 experts,including 3 obstetric clinical experts,7midwifery experts,4 clinical nursing specialists and 1 midwife education experts.They come from Beijing,Shanghai,Shenzhen,Yilan（Taiwan）,Handan,Haikou and other multiple regions,which supply a good regional and disciplinary representation for this research.After the implementation of two rounds of expert consultation,the content template of the birth plan was initially established,include 8 first level index、32 secondary indicators and 80three indicators,based on this experts’advice,a preliminary test was taken to adjusted and modified the indicators,finally established the birth plan content template.2.The application results of delivery plan based on continuous partnership（1）Baseline Situations of two groups:the results of comparing the general materials of the intervention group and the control group showed that the differences between the two groups were not statistically significant（P>0.05）and the two groups were comparable.（2）Comparison of the Delivery Results of the Two Groups:the duration of the first stage of delivery,total delivery duration,amount of bleeding in the first 2 hours after delivery,rate of Caesarean section and rate of non-medically indicated Caesarean section of the intervention group were lower than that in the control group and the differences between two groups were statistically significant（P<0.05）;the differences in the duration of the second stage of delivery and the third stage of delivery,usage rate of oxytocin and rate of episiotomy between the two groups were not statistically significant（P>0.05）.（3）Comparison of the Newborn Conditions of Two Groups:the number of newborns transferred to NICU in the intervention group was less than that in the control group and the difference between the two groups was statistically significant（P<0.05）;the differences in Apgar scores of newborns in one minute and five minutes after birth between the two groups were not statistically significant（P>0.05）.（4）Comparison of the Anxiety Degrees of Pregnant Women in Two Groups:the difference in anxiety degree between the two groups was not statistically significant（P>0.05）;when the pregnant women of two groups waited for delivery in the delivery room,the anxiety degree of the pregnant women in the control group was higher than that in the intervention group and the difference between two groups was statistically significant（P<0.05）;during the process of delivery,the anxiety degree of the pregnant women in the two groups was higher than the level when they just selected in the group;the differences between two groups were statistically significant（P<0.05）.（5）Comparison of the Obstetric Service Satisfactions of Two Groups:the pregnant women in the intervention group had higher satisfaction degree in the aspect of antenatal examination,knowledge publicity and education,question answering and delivery than that in the control group,moreover,the differences between the two groups were statistically significant（P<0.05）.The difference in satisfaction degree in the aspects of knowledge publicity and education during puerperium between the two groups was not statistically significant（P>0.05）.【Conclusion】1.The content template of the birth plan was constructed,which proved to be scientific and reliable,and could provide reference for future research and clinical application of the birth plan.2.The implementation of the birth plan based on partnership could boost the connection and trust between a midwife and pregnant woman,promote the mutual communication and understanding,effectively improve the results of infant and mother,reduce the duration of delivery,the amount of bleeding in the first 2 hours after delivery,rate of Caesarean section,especially the rate of non-medically indicated Caesarean section,decrease the anxiety degree of pregnant women and the transfer rate of newborns,improve the mental health of pregnant women and eventually increase the delivery service satisfaction,enrich the role connotation of midwives,it can drive the further development of the midwifery industry and service level.