تأثیر حضور همراه ماما و همراه غیرماما بر میزان درد زایمان، طول مدت زایمان و میزان استفاده از اکسی‌توسین در زنان نخست‌زا: یک کارآزمایی بالینی

نوع مقاله: اصیل پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد مشاوره در مامایی، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

2 دانشکده بهداشت، دانشگاه علوم پزشکی قزوین، قزوین، ایران. دانشجوی دکترای اپیدمیولوژی، گروه اپیدمیولوژی و آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی تهران، تهران، ایران

3 استادیار سلامت جامعه، گروه مامایی و بهداشت مادر و کودک، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی قزوین، قزوین، ایران.

4 مربی گروه پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی اراک، اراک، ایران.

چکیده

مقدمه: یکی از روش‌های کاهش درد زایمان، حمایت مداوم از مادر باردار در طول لیبر و زایمان است. رضایت زنان از تجربیات زایمان از نظر ارائه‌دهندگان مراقبت، سیاست‌گذاران سیستم بهداشتی- درمانی به‌‌عنوان یکی از شاخص‌های مهم کیفیت مراقبت از مادر تلقی می‌گردد. با توجه به نتایج متناقص مطالعات و کمبود شواهدی که تأثیر حضور همراه حرفه‌ای و غیر‌حرفه‌ای را بر زایمان مقایسه کند، مطالعه حاضر با هدف مقایسه تأثیر حضور همراه ماما و غیرماما بر میزان درد زایمان، طول مدت زایمان و میزان استفاده از اکسی‌توسین در زنان نخست‌زا انجام گرفت.
روش‌کار: این مطالعه کارآزمایی بالینی تصادفی شده در سال 97-1396 بر روی 120 زن نخست‌زا شامل سه گروه همراه ماما، همراه غیرماما و گروه کنترل انجام گردید. پیامدهای مطالعه مقیاس عددی درد، طول مدت مراحل زایمان و میزان استفاده از اکسی‌توسین بود. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه20) و آزمون‌های کای اسکوئر، آنالیز واریانس یک‌طرفه و آنالیز واریانس اندازه‌های تکراری انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: در ابتدای فاز فعال، نمره درد در گروه همراه ماما 83/1±56/2، در گروه همراه غیرماما 46/2±03/4 و در گروه کنترل 89/2±06/4 بود که از نظر آماری تفاوت معناداری را نشان داد (014/0=p). بر اساس نتایج، اثر زمان (001/0p<) معنی‌دار بود، ولی اثر گروه (386/0=p) و اثر متقابل زمان و گروه (538/0=p) از نظر آماری معنادار نبود. بر اساس نتایج آزمون آنالیز واریانس یک‌طرفه، کمترین طول مدت زایمان در هر دو مرحله مربوط به گروه همراه ماما بود (05/0>p). همچنین بر اساس نتایج، گروه همراه ماما در مقایسه با سایر گروه‌ها از اکسی‌توسین کمتری استفاده کرده بودند (004/0=p).
نتیجه‌گیری: وجود مامای همراه در کنار مادران زائو، یک مداخله غیر‌تهاجمی و تأثیرگذار در ایجاد آرامش جسمی و روانی در طول لیبر و زایمان است.

کلیدواژه‌ها


عنوان مقاله [English]

Effect of the presence of midwife and non-midwife companion on labor pain, duration of delivery, and amount of oxytocin drops in primiparous women: a clinical trial study

نویسندگان [English]

  • Masuomeh Darvishi 1
  • Mehdi Ranjbaran 2
  • Zinat Jourabchi 3
  • Hadi Jafarimanesh 4
1 M.Sc. student of Counseling in Midwifery, Student Research Committee, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.
2 School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran. PhD candidate in Epidemiology, Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
3 Assistant professor, Department of Community Health, Department of Maternal and Child Health and Midwifery, Social Determinants of Health Research Center, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
4 Instructor, Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran.
چکیده [English]

Introduction: One of the methods of reducing labor pain is continuous support for pregnant women during labor and delivery. Women's satisfaction from labor experience in terms of care providers, policy-makers of health-care system is considered as one of the important indicators in the quality of mother care. According to controversial results of the studies and lack of evidence which compare the effect of professional and non-professional presence on labor, this study was performed with aim to compare the effect of presence of midwife and non-midwife companion on labor pain, duration of delivery and amount of oxytocin use in primiparous women.
Methods: This randomized clinical trial study was performed on 120 primiparous women including three groups of midwives, non-midwife and control group in 2017-2018. The outcome of the study included numerical scale of pain, duration of delivery stages and the amount of oxytocin drops. Data analysis was done using SPSS software (version 20) and Chi-square test, one-way ANOVA and repeated measures analysis of variance. PResults: At the beginning of active phase, pain score in midwife companions group was 2.56 ± 1.83, in non-midwife companions group was 4.03 ± 2.46 and in control group was 4.03 ± 2.46, which showed statistically significant difference (P = 0.014). The effect of time (P <0.001) was significant, but the effect of group (P = 0.386) and the interaction between time and group (P = 0.538) were not statistically significant. According to the results of one-way ANOVA, the least length of delivery in both stages was related to midwife group (P <0.05). Also, midwife companions group had used less oxytocin compared with other groups (P = 0.004).
 Conclusion: The presence of a midwife companion beside mothers is a non-invasive and effective intervention in creating physical and mental relaxation during labor and delivery.

کلیدواژه‌ها [English]

  • Labor pain
  • Labor support
  • Midwife companion
  • Non-midwife companion
  • Oxytocin
  1. Ranjbaran M, Khorsandi M, Matourypour P, Shamsi M. Effect of massage therapy on labor pain reduction in primiparous women: A systematic review and meta-analysis of randomized controlled clinical trials in Iran. Iran J Nurs Midwifery Res 2017; 22(4):257-61.
  2. Phumdoung S, Good M. Music reduces sensation and distress of labor pain. Pain Manag Nurs 2003; 4(2):54-61.
  3. Bonapace J, Gagné GP, Chaillet N, Gagnon R, Hébert E, Buckley S. No. 355-Physiologic basis of pain in labour and delivery: an evidence-based approach to its management. J Obstet Gynaecol Can 2018; 40(2):227-45.
  4. Spong C. Obstetrical hemorrhage. In: Cunningham FG, Leveno KJ, Bloom SL, editors. Williams obstetrics. New York: McGraw--Hill Professional; 2010. P. 757-803.
  5. Johnson R, Slade P. Does fear of childbirth during pregnancy predict emergency caesarean section? BJOG 2002; 109(11):1213-21.
  6. Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, Bréart G. Postpartum maternal mortality and cesarean delivery. Obstet Gynecol 2006; 108(3):541-8.
  7. Pashib M, Tarjoman Parashkooh R, Mostafavi FS, Abbasi O. Pain intensity, labor duration and satisfaction of labor between anesthesia with fentanyl injection and anesthesia with water injection in women undergoing vaginal delivery. J Torbat Heydariyeh Univ Med Sci 2016; 4(3):31-7. (Persian).
  8. Lang AJ, Sorrell JT, Rodgers CS, Lebeck MM. Anxiety sensitivity as a predictor of labor pain. Eur J Pain 2006; 10(3):263-70.
  9. Beigi NM, Broumandfar K, Bahadoran P, Abedi HA. Women’s experience of pain during childbirth. Iran J Nurs Midwifery Res 2010; 15(2):77-82.
  10. Toosi SZ, Mohammadinia N, Sereshti M. Effect of Companionship during Labor on Level of Anxiety of Primiparous Mothers and Midwives Points of View in Iranshahr, 2010. Journal of Mazandaran University of Medical Sciences. 2013;22(96):41-8. (persian).
  11. Lundgren I. Swedish women's experiences of doula support during childbirth. Midwifery. 2010;26(2):173-80.
  12. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain--United States, 2016. JAMA 2016; 315(15):1624-45.
  13. Minnie K, Klopper HC. Developing a research focus in implementing continuous support during labour as best practice. Vanderbijlpark, South Africa: North-West University; 2016.
  14. Bruggemann OM, Parpinelli MA, Osis MJ, Cecatti JG, Neto AS. Support to woman by a companion of her choice during childbirth: a randomized controlled trial. Reprod Health 2007; 4(1):5.
  15. Essex HN, Pickett KE. Mothers without companionship during childbirth: an analysis within the millennium cohort study. Birth 2008; 35(4):266-76.
  16. Dadshahi S, Torkzahrani S, Janati-Ataie P, Nasiri M. Does continuous labor support by midwife make a difference in delivery outcomes? Iran J Obstet Gynecol Infertil 2018; 20(12):67-76. (Persian).
  17. Kaplan BJ. Kaplan and Sadock’s synopsis of psychiatry. behavioral sciences. Clin Psychiatry 2016; 58(1):78-9.
  18. Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J. Continuous support for women during childbirth. Cochrane Database Syst Rev 2011; 2(2):CD003766.
  19. Samieizadeh Toosi T, Sereshti M, Dashipur A, Mohammadinia N, Arzani A. The effect of supportive companionship on Length of labor and desire to breastfeed in primiparous Women. J Urmia Nurs Midwifery Facul 2011; 9(4):262-9. (Persian).
  20. Gilliland AL. After praise and encouragement: Emotional support strategies used by birth doulas in the USA and Canada. Midwifery 2011; 27(4):525-31.
  21. Hodnett ED, Lowe NK, Hannah ME, Willan AR, Stevens B, Weston JA, et al. Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial. JAMA 2002; 288(11):1373-81.
  22. Gagnon AJ, Waghorn K, Covell C. A randomized trial of one‐to‐one nurse support of women in labor. Birth 1997; 24(2):71-7.
  23. Nobakht F, Safdari DF, Parvin N, Rafiee VL. The effect of the presence of an attendant on anxiety and labor pain of primiparae referring to Hajar Hospital in Shahre Kurd, 2010. J Res Dev Nurs Midwifery 2012; 9(1):41-50. (Persian).
  24. Bech P, Gormsen L, Loldrup D, Lunde M. The clinical effect of clomipramine in chronic idiopathic pain disorder revisited using the Spielberger State Anxiety Symptom Scale (SSASS) as outcome scale. J Affect Disord 2009; 119(1-3):43-51.
  25. Dehcheshmeh FS, Rafiei H. Complementary and alternative therapies to relieve labor pain: a comparative study between music therapy and Hoku point ice massage. Complementary Ther Clin Pract 2015; 21(4):229-32. (Persian).
  26. Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y. The visual analog scale for pain: clinical significance in postoperative patients. Anesthesiology 2001; 95(6):1356-61.
  27. Towery S, Fernandez E. Reclassification and rescaling of McGill Pain Questionnaire verbal descriptors of pain sensation: a replication. Clin J Pain 1996; 12(4):270-6.
  28. Effati-Daryani F, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Taghizadeh M, Mohammadi A. Effect of lavender cream with or without foot-bath on anxiety, stress and depression in pregnancy: a randomized placebo-controlled trial. J Caring Sci 2015; 4(1):63-73.
  29. Melzack R, Katz J. The McGill pain questionnaire: appraisal and current status. New York: Guilford Press; 2001.
  30. Nobakht F, Safdari DF, Parvin N, Rafiee VL. The effect of the presence of an attendant on anxiety and labor pain of primiparae referring to Hajar Hospital in Shahre Kurd, 2010. J Res Dev Nurs Midwifery 2012; 9(1):41-50. (Persian).
  31. Kamali Fard M, Alizadeh R, Sehati Shafaei F, Gojazadeh M. The effect of lifestyle on the rate of preterm birth. J Ardabil Univ Med Sci 2010; 10(1):55-63.
  32. Khavandizadeh Aghdam S, Kazemzadeh R, Nikjoo R. The effect of the doula support during labor on delivery length in primigravida women. Iran J Obstet Gynecol Infertil 2015; 18(150):8-13. (Persian).
  33. Javad Nouri M, Afshari P, Montazeri S, Latifi SM. The effect of continuous labor support by accompanying person during labor process. Jundishapur Sci Med J 2008; 7(1):32-8. (Persian).
  34. Pascali‐Bonaro D, Kroeger M. Continuous female companionship during childbirth: a crucial resource in times of stress or calm. J Midwifery Womens Health 2004; 49(4 Suppl 1):19-27.
  35. Ahmadi Z. Evaluation of the effect of continuous midwifery support on pain intensity in labor and delivery. J Rafsanjan Univ Med Sci 2010; 9(4):293-304. (Persian).
  36. Simkin P, Frederick E. Supportive strategies for childbirth: Labor support. Childbirth education, practice, research and theory, 2nd ed Philadelphia (PA): WB Saunders. 2000.
  37. McGrath SK, Kennell JH. A randomized controlled trial of continuous labor support for middle‐class couples: effect on cesarean delivery rates. Birth 2008; 35(2):92-7.
  38. Nommsen‐Rivers LA, Mastergeorge AM, Hansen RL, Cullum AS, Dewey KG. Doula care, early breastfeeding outcomes, and breastfeeding status at 6 weeks postpartum among low‐income primiparae. J Obstet Gynecol Neonatal Nurs 2009; 38(2):157-73.