[[alternative]]Effect of “Rollover sequence Program” on Labor During, Birth Outcomes and Childbirth Satisfaction in Women Undergoing Epidural Anesthesia During Labor

[[abstract]]研究背景 硬脊膜外麻醉為臨床上緩解生產疼痛常見的方式之一，盛行率逐年增加，硬脊膜外麻醉對產程時間以及分娩方式的影響，一直以來存在著爭議。婦女於待產期間下床自由活動及改變姿勢，可促進產程進展，但部分使用硬脊膜外麻醉的婦女，因為醫療常規或下肢無力，被受限於床上待產。因此，本研究將比較於待產期間使用硬脊膜外麻醉婦女運用床上姿勢改變方案對於生產結果與生產滿意度的影響。研究目的 評價於待產期間使用硬脊膜外麻醉婦女運用床上姿勢改變方案對產程、生產結果及生產滿意度的影響，研究結果指標包括第一產程與第二產程時間、生產方式與生產滿意度。研究方法 本研究假設使用硬脊膜外麻醉婦女於待產期間運用床上姿勢改變方案在第一產程時間、第二產程時間、生產方式以及生產滿意度有差異。採實驗性研究設計，於中部某醫學中心進行收案，經過篩選符合收案條件的婦女，隨機分派至實驗組與對照組，實驗組於待產期間使用硬脊膜外麻醉且子宮頸口開5公分時提供床上姿勢改變方案，至少每30分鐘改變一次姿勢，並運用花生球輔助；對照組於待產期間使用硬脊膜外麻醉，給予的常規護理指導，比較兩組在第一產程時間、第二產程時間、生產方式與生產滿意度是否有差異。研究結果 本研究共121位研究對象完成研究資料收集，分別為實驗組57人、對照組64人。研究結果發現，實驗組與對照組在第一產程時間、第二產程時間、生產方式及生產滿意度皆無顯著差異。但床上姿勢改變的翻身率為指標時，發現與產程時間呈現顯著負相關。此外，研究發現，若以床上姿勢改變翻身率高低區分，高翻身率組婦女在活動期時間及第二產程時間皆有顯著縮短。在活動期時間，高翻身率組婦女（M=114.57分鐘，SD=91.36）較低翻身率組婦女（M=335.36分鐘，SD=205.46）顯著縮短（p< .001）；在第二產程時間，高翻身率組（M=37.33分鐘，SD=34.26）亦較低翻身率組婦女（M=63.95分鐘，SD=57.97）顯著縮短（p< .01）。翻身率高低與生產方式及生產滿意度之比較無顯著差異。結論與應用 待產期間使用硬脊膜外麻醉的婦女於床上姿勢改變的翻身率與產程時間呈現顯著負相關。高翻身率組的婦女可顯著縮短活動期時間及第二產程時間。若待產環境中未能提供花生球給予待產婦女，鼓勵婦女於床上頻繁改變姿勢亦能顯著減少活動期時間及第二產程時間。期望透過產科照護人員的在職教育以及在懷孕婦女參與產前父母教室，讓其了解待產期間姿勢改變重要性並且落實於產科照護中。[[abstract]]Research background Epidural anesthesia is one of the common methods to relieve labor pain, and its prevalence is increasing. The outcome of spinal anesthesia to the during of labor and labor methods has always been controversial. Women get out of bed and move freely and change their postures during labor, which can shorten the progress of labor. However, some women who use epidural anesthesia are restricted to bedridden due to medical routines or weakness of the lower limbs. Therefore, this study will compare the effects of using the bed posture change program to delivery outcome and childbirth satisfaction in women undergoing epidural anesthesia during labor.Research purpose To evaluate the effect of women using epidural anesthesia on the birth outcome and production satisfaction of women using epidural anesthesia during labor, the results of the study include the first and second labor stages, delivery methods and childbirth satisfaction.Methodology This study assumes that women who used epidural anesthesia using the bed posture change program during the labor period to have differences in the time of the first stage of labor, the time of the second stage of labor, the mode of delivery, and the childbirth satisfaction. Adopting an experimental research design and accepting cases in a medical center in the central part of China. After screening, women who meet the acceptance criteria are randomly distributed to the experimental group and the control group. The experimental group uses spinal epidural anesthesia during the labor period and cervical dilation 5cm, provides a plan for the rollover sequence program change posture at least every 30 minutes and use peanut ball to assist; the control group used spinal epidural anesthesia during the period of labor, and was given routine nursing guidance. Compare the two groups in the first stage of labor, the second stage of labor, delivery methods and childbirth satisfaction.Results In this study, a total of 121 subjects completed the research data collection, including 57 in the experimental group and 64 in the control group. The results of the study found that there were no significant differences between the experimental group and the control group at the time of the first stage of labor, the time of the second stage of labor, delivery methods and childbirth satisfaction. However, when the turning rate of bed posture changes was an indicator, it was found to be significantly negatively correlated with labor time. In addition, the study found that if the change in bed posture is used to distinguish between high and low posture changes rates, women in the high posture changes rate group have significantly shorter time during the active period and the second stage of labor. During the active period, women in the high posture changes rate group (M=114.57 minutes, SD=91.36) women in the low posture changes rate group (M=335.36 minutes, SD=205.46) were significantly shorter (p< .001); time in the second stage of labor Women in the high posture changes rate group (M=37.33 minutes, SD=34.26) were also significantly shorter in the low posture changes rate group (M=63.95 minutes, SD=57.97) (p< .01). There is no significant difference between the rate of posture changes and the delivery method and childbirth satisfaction. Conclusion and Application The posture changes rate of women using epidural anesthesia in bed during labor is significantly negatively correlated with the time of labor. Women in the high posture changes rate group can significantly shorten the time of the active period and the second stage of labor. If peanut balls are not provided to expectant women in the expectation environment, encouraging women to change their positions frequently in bed can also significantly reduce the time during the active period and the second stage of labor. It is hoped that through on-the-job education of obstetric care staff and participation in antenatal parents’ classrooms for pregnant women, they can understand the importance of postural changes during delivery and implement them in obstetric care