Aims: To investigate childbearing women's views, experiences and decision-making related to epidural analgesia in labour.
Design: Mixed-methods systematic review.
Data sources: A comprehensive literature search was implemented across Medline, CINAHL and EMBASE from 2000 to September 2018. The literature search was undertaken in January 2018 and updated in September 2018. Thirty papers were selected.
Results: Four overarching synthesized findings were identified: (a) choice; (b) pain management experience; (c) lack of information; and (d) information provision and consent.
Review methods: Quality appraisal was conducted using JBI levels of evidence and other established tools. NVivo was used to independently dual code and thematically synthesize qualitative data. A narrative synthesis of the quantitative findings from the included studies was undertaken. The GRADE-CERQual approach was used to assess confidence in the review findings based on the qualitative data. A set of integrated mixed-methods synthesized findings was produced.
Conclusion: Recommendations for practice based on the systematic review findings are that midwives should dedicate time to discuss epidural with women and birth partners, ideally during the second or third trimester of pregnancy, asking women what coping strategies or pain relief they have been considering, if any. The factors which may influence the woman's choice of epidural, including pain threshold, ability to cope with pain, timing of epidural and length of labour should be continuously evaluated during labour. The midwife should remain with women after an epidural has been sited, demonstrating understanding of the woman's choice and providing an opportunity for discussion of plans for the remaining labour and birth.
Impact: The findings of this systematic review can inform both healthcare professionals and service users on various aspects of the decision-making process about the use of epidural analgesia in labour. Data can be transferable to similar settings in high-income countries.
目的: 调查育龄妇女对分娩时硬膜外镇痛的看法、经验和决策。 设计: 混合法系统评价。 数据来源: 2000年至2018年9月期间,在数据库Medline、CINAHL和EMBASE上实施了全面的文献检索。文献检索于2018年1月进行,2018年9月更新。选取了30篇论文。 结果: 确定了四项主要综合调查结果:(a)选择;(b)疼痛管理经验;(c)缺乏信息;以及(d)信息提供和同意。 审查方法: 利用JBI证据等级和其他既定工具进行质量评价。使用NVivo分析软件对定性数据进行独立的对偶码和主题综合。对纳入的研究中的定量结果进行了叙述性综合。采用GRADE-CERQual方法评估基于定性数据的审查结果的置信水平。编制了一套综合的混合法综合调查结果。 结论: 根据系统评价调查结果提出的实践建议是,助产士应专门抽出时间与妇女和分娩陪护人员讨论硬膜外麻醉,最好是在怀孕的第二个月或第三个月,询问产妇一直考虑的应对策略或疼痛减轻措施(如有)。在分娩过程中应持续评估可能影响产妇选择硬膜外镇痛的因素,包括疼痛阈值、应对疼痛的能力、硬膜外镇痛时间和分娩时间。在硬膜外麻醉已到位后,助产士应继续陪在产妇身边,对产妇的选择表示理解,并提供机会讨论后续分娩和生产计划。 影响: 本系统评价的调查结果可以为医疗保健专业人员和服务用户提供关于分娩时使用硬膜外镇痛的决策过程的各个方面的信息。在高收入国家的类似环境中,此类数据亦可转用。.
Keywords: analgesia; childbirth; choice; consent; decision-making; epidural; labour; nursing; pain relief; systematic review; women.
© 2020 John Wiley & Sons Ltd.