| Summary: | 碩士 === 國立臺北護理健康大學 === 護理助產研究所 === 105 === 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<.001）for perceived uncertainty, and 2.1 points lower（p<.001）for anxiousness in the experimental group than in the control group. Additionally, admissions made on the first visit to the hospital were significantly higher in the experimental group（χ2=10.14, p=.001）while the number of admission rejections and the number of medical consultations were significantly lower in the experimental group（t=3.52, p=.001 and t=5.51, p<.001, respectively）. Furthermore, upon admission to the delivery room, the experimental group had better mean cervix dilation（t =-3.80, p<.001）, a lower rate of induced delivery （χ2=9.63, p=.002）, and a lower incidence of infant admission to the observation / neonatal intensive care unit（χ2=11.51, p=.001）than the control group. However, no significant differences（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.
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