[[alternative]]Effectiveness of the Timing of Labor Admission Educational Program for Pregnancy Women on Locus of Labor Control and Birth Outcomes

[[abstract]]研究背景：當生產由過去的居家分娩轉型成現代化醫療場景時，陌生的人、事、物，容易使婦女對生產失去自我控制，並且出現焦慮及不確定感受，因此研究並教育婦女在正常產程啟動時，面臨產兆的因應措施，學習在家裡的待產自我照護，等候適切的入院待產時機，可以幫助婦女減少往返產房、家中的辛苦，及非必要的醫療措施，維持良好的生產控制感及待產分娩結果。研究目的：探討入院待產教育方案於婦女生產控制感及待產分娩結果之成效。研究方法：採類實驗研究設計法，於北部某一醫學中心收案，以連續性方便取樣年滿20歲、妊娠35週以上，母胎無異常合併症之單胞胎初產婦為研究對象，共計有效樣本151位，實驗組76人接受入院待產教育方案、對照組75人給予常規性生產護理指導，研究工具為結構式問卷：基本人口產科學資料、不確定感與焦慮感視覺類比量表、生產控制量表、待產及分娩結果資料，於妊娠35週以上的產檢日、產後3天內填寫問卷量表。研究結果：在調整前測分數及人口產科學干擾變項後，實驗組比對照組的生產控制感佳8.91分（p=.001）、不確定感低3.66分（p.05）。結論及臨床應用：入院待產教育方案能使婦女擁有較高的生產控制感受、較低的不確定感及焦慮感受，掌握較正確入院待產時機，減少被遣返及諮詢次數，並於住院時具有較佳的子宮頸擴張程度、減低待產時催生機會，且有較高產後親子同室或新生兒入住嬰兒室比率。建議藉由入院待產教育方案，鼓勵婦女當無出現危險徵兆時，盡可能延長第一產程潛伏期的居家時間，以提高其生產控制感、降低不確定感、焦慮感及維持較佳的待產分娩結果。關鍵詞：入院待產、生產教育、生產控制感、不確定感、焦慮感、待產分娩結果。[[abstract]]Background: The shift in the setting for labor and delivery from the home to the hospital places expectant mothers into unfamiliar environments and circumstances that readily induce feelings of loss of control, anxiousness, and uncertainty. Thus, research and education related to the proper response of women experiencing normal labor to the onset of labor and to proper home self-care techniques prior to hospital admission are beneficial in terms of minimizing the number of labor-related hospital trips, the burdens on the family, and the wastage of medical resources as well as in terms of restoring good locus of control to the mother and improving birth outcomes.Purpose: To explore the effect of an admission in labor education program on the perceived locus of control and labor / delivery outcomes of expectant mothers.Methods: A quasi-experimental research design and consecutive convenience sampling were used to recruit participants from among patients at a medical center in northern Taiwan. Eligible participants were primipara women who were 20 years of age or older and in at least the 35th week of a complications-free pregnancy with a single fetus. A total of 151 participants were enrolled, with 76 assigned to the experimental group and 75 assigned to the control group. The experimental group received the labor and delivery education program intervention while the control group received standard nursing guidance. A structured questionnaire including a basic OB/GYN datasheet, the Visual Analogue Scale（VAS）of uncertainty and anxiety, the Labor Agentry scale（LAS）, and birth-outcome information was used to collect data. Participants completed the two scales at each prenatal checkup after the 35th gestational week and at 3-days postpartum.Results: After adjusting for pretest scores and confounding obstetrics variables, the mean posttest scores were 8.91 points higher（p=.001）for perceived locus of control, 3.66 points lower（p.05）were found between the two groups in terms of: epidural analgesia; duration of first-stage labor; duration spent in the delivery room, in the hospital, or in labor; method of delivery; assisted birth; incidence of perineal laceration; postpartum bleeding; or Apgar scores.Conclusions and Implications for Practice: The findings support the effectiveness of providing a timing of labor admission education program in terms of enhancing the locus of control during birth, lowering perceived uncertainty and anxiousness, increasing awareness of the proper time for admission after the onset of labor, and reducing the numbers of repeat trips to the hospital and medical consultations. Further, the program may improve the cervical dilation status of women at admission and reduce the need for induced deliveries while increasing the rate of rooming-in / nursery placement. In the absence of contraindications, this education program should be provided to expectant mothers as an effective method to maximize the duration of the at-home latent phase of labor in order to increase locus of control over delivery, reduce uncertainty and anxiousness, and attain optimal birth outcomes.Key Words: labor admission, prenatal education, labor-related locus of control, uncertainty, anxiety, birth outcomes