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Samfelld ljósmæðraþjónusta : raunhæfur valkostur í barneignarferlinu

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Authors
Árdís Ólafsdóttir
Issue Date
2005-11-01

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Other Titles
Continuity of midwifery care – a realchoice during pregnancy and childbirth
Citation
Ljósmæðrablaðið 2005, 83(2):6-11
Abstract
This article is about continuity of care within midwifery. The concept is examined as well as the organisation of different continuity schemes. Advantages and disadvantages, mainly from the perspective of midwives are explored. The article is based on the literature review chapter of my masters research from 1999 together with the conclusions of that research and some new literature from the last five years. The topic of the research was the attitudes and willingness of Icelandic midwives towards working within continuity of carer service. The sample was midwives working at the Women´s Unit of the University Hospital of Iceland, where it had been decided to form a group of midwives practising continuity of carer. A team of midwives practising continuity of care exsisted at the hospital since 1994 (MFS). A questionnaire was sent to midwives working at the hospital since the new group would constitute midwives working there. The midwives were asked about their attitudes and willingness to work within continuity of carer and the results linked to background information such as age, marital position, number and age of children, education and experience (Ólafsdóttir, 1999). The experience of the continuity of care groups during the last ten years has been positive and the midwives have to deny many women access each month because they are fully booked. This satisfaction with care of models offering continuity of care is in accordance with other research (Biro et al 2003; Brown & Lumley 1994; McCourt & Page 1996; van Teijlingen et al 2003). Continuity schemes have positive effects on midwives´ job satisfaction, where the most influential factors are the relationship between the woman and her midwife, better use of their skills and knowledge, control over time and work. However some of the midwives quit continuity of care schemes because they find the on call system too binding and stressful (Allen et al 1997; Green et al 1998; Sandall 1997). Prospective parents are increasingly offered continuous midwifery care in Iceland, especially during pregnancy and post partum. No one model is the only right one, but it is important to have a real choice and to offer different choises emphasising continuity during the childbearing process, for both women and midwives.
Í þessari grein verður fjallað um samfellda þjónustu ljósmæðra, þar sem hugtakið er skoðað, innleiðing slíkra þjónustuforma, kostir og gallar, aðallega frá sjónarhorni ljósmæðra. Greinin er byggð á fræðilegum kafla rannsóknar minnar úr meistaranámi frá 1999 og verða niðurstöður hennar fléttaðar inn í umræðuna, auk heimilda frá undanförnum fimm árum. Fjallaði rannsóknin um viðhorf og vilja íslenskra ljósmæðra til þess að starfa við samfellda ljósmæðraþjónustu. Rannsóknin var gerð á Kvennadeild LSH, þar sem fyrirhugað var að bæta við ljósmæðrahóp, sem veitti samfellda þjónustu í gegn um allt barneignarferlið, en þar hafði verið starfandi slíkur hópur frá árinu 1994 (MFS). Spurningalisti var sendur til allra starfandi ljósmæðra á Kvennadeild LSH, alls 111 ljósmæðra, þar sem sýnt var að ljósmæður hins nýja hóps kæmu úr þeirra röðum. Spurt var um viðhorf og áhuga ljósmæðranna á að starfa við samfellt þjónustuform og niðurstöður tengdar við lýðfræðilegar upplýsingar, svo sem aldur, hjúskaparstöðu, fjölda og aldur barna, nám og reynslu. Alls svöruðu 69 ljósmæður eða 62,2% (Árdís Ólafsdóttir, 1999). Reynsla síðastliðinna 10 ára af MFS einingunni hefur verið jákvæð, og komast færri konur að en vilja og er það í samræmi við erlendar rannsóknir, þar sem konur lýsa ánægju með umönnun og þjónustu í samfelldu þjónustukerfi (Biro, Waldenström, Brown og Pannifex, 2003; Brown og Lumley, 1994; McCourt og Page, 1996; van Teijlingen, Hundley, Rennie, Graham og Fitzmaurice, 2003). Samkvæmt rannsóknum hefur samfelld þjónusta jákvæð áhrif á starfsánægju ljósmæðra, þar sem þættir eins og sambandið, sem þær mynda við konuna, betri nýting hæfni þeirra og þekkingar, stjórn á vinnu þeirra og vinnutíma hafa hvað mest áhrif. Samt sem áður virðist mikið álag og binding valda því að sumar ljósmæðranna gefast upp og hætta (Allen, Bourke Dowling og Williams, 1997;Green, Curtis, Price og Renfrew, 1998; Sandall, 1997). Verðandi foreldrum er í auknum mæli boðið upp á samfellda þjónustu ljósmæðra á Íslandi, einkum í meðgönguvernd og sængurlegu. Ekkert eitt þjónustuform er það eina rétta en mikilvægt er að samfelld þjónusta ljósmæðra sé raunhæfur valkostur og að boðið sé upp á mismunandi valkosti í barneignarferlinu, með áherslu á samfellu, þannig að konur og ljósmæður geti fundið það þjónustuform sem þeim hentar.
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