Impact of continuous support to a small group of women by midwifery students on women's childbirth experience in the public maternity hospital, Mongolia

概要

Purpose: The aim of this study is to explore the effect of the continuous support during labor and childbirth by a midwifery student for a small group of parturient women on the women’s experience with childbirth and birth outcome in a public maternity hospital.

Participants and Methods: One-group posttest-only quasi-experimental design using an independent pretest sample was conducted at one of the four public maternity hospitals in Ulaanbaatar, the capital city, Mongolia between September 2019, and January 2020. The study intervention was the continuous support during labor and delivery (CSLD) by the midwifery baccalaureate senior students to 2 - 4 laboring women. Inclusion criteria were low-risk pregnant women, who had a spontaneous vaginal delivery, gestational age of 37 to 41 weeks, and had singleton healthy newborns. Childbirth Experience Questionnaire (CEQ) and Women`s satisfaction with care and childbirth outcome forms were used for data collection.

Results: In total 828 women participated in this study, 420 (43.6%) and 408 (50.2%) women in the pre-intervention and intervention group. There were no significant differences in demographic and obstetric data between groups. Duration in the labor room was significantly shorter among multiparous women (5.2±2.4 hours vs 6.2±4.8 hours) and women who received oxytocin to augment labor (6.8±1.6 hours vs 7.8±5.5 hours ) in the intervention group. No differences in the use of oxytocin to augment labor and episiotomy or perineal tears between groups. Overall and domain scores of the CEQ were higher in the intervention group. After adjusting for parity and oxytocin use, the intervention was significantly associated with increased scores of the CEQ. The proportion of women who scored their experienced level of satisfaction with labor, delivery, and early postpartum care more than 80% were significantly higher (p<0.05) in the intervention (91.9%, 92.2%, and 95.6%) than pre-intervention group (53.1%, 85.0%, and 71.2%).

Discussion: The study findings showed no significant differences in clinical outcomes, except duration in the labor room. Women`s positive childbirth experience and satisfaction with care were significantly higher in the intervention than in the pre-intervention group. The intervention was very well accepted not only by laboring women, but also by faculty members, students, and the hospital health providers.

Conclusion: We believe those study findings have a potential impact on maternal health policymakers and further expansion of the doula implementation at other maternity hospitals not only in Mongolia but also in countries that have similar health care systems and maternity care to promote respectful high-quality women-child-family centered care.