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Master Thesis

Comment les nouvelles recommandations pour la pratique clinique sur l’administration d’oxytocine au cours du travail spontané s’inscrivent dans la pratique des sages-femmes et des coordinatrices sages-femmes d’Ile-de-France ?

Abstract : Background: the National College of Midwifes of France published Clinical Practice Guidelines (CPG) in 2016, and concluded that the oxytocin must not be considered anymore as another inoffensive prescription. Considering its daily and widely use during spontaneous labour, midwifes must absolutely know about, agree with and apply these guidelines to reach a best care of foetus and mothers. Objective: to assess the implementation of CPG about oxytocin administration during spontaneous labour in midwifes’ practice in Ile-de-France. Patients and methods: the quantitative observational tranverse multicenter study, used an anonymous online questionnaire, such as GoogleForms®, which was sent by email to the 81 motherhoods of Ile-de-France, from June 8th to November 11th, 2018. Results: we collected 536 answers, inclunding 29 coordinator midwifes and 507 midwifes, working in 58 motherhoods of Ile-De-France. The population of the study had a good knowledge of guidelines. 46,2% midwifes declared to implement them for more than 7 out of 10 eligible women. The midwifes, who implemented them significantly more, had read precisely the text (p=0,001), had a better knowledge (≥ 13/20) (p<0,001) and a better global agreement (p<0,001). The identified hurdles significantly associated to a lower implementation of the guidelines were: department organisation (p<0,001), workload and lack of time (p<0,001), text of the guidelines (p<0,001) and patients’ point of view (p<0,001). The more important hurdle identified was the workload and the lack of time (p=0,002). The element which had more impact on guidelines’ implementation was the updating protocols of departments (p=0,013). Conclusion: the study shows the necessity of using rigorous model to implant new guidelines in the practice of professionals. It is important to suggest practical solutions to change their practice, to identify hurdles and elements promoting this change. The purpose is to implement interventions and to eliminate hurldes for improving care of patients.
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Submitted on : Tuesday, October 1, 2019 - 3:40:36 PM
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Barbara Duret-Robert. Comment les nouvelles recommandations pour la pratique clinique sur l’administration d’oxytocine au cours du travail spontané s’inscrivent dans la pratique des sages-femmes et des coordinatrices sages-femmes d’Ile-de-France ?. Gynécologie et obstétrique. 2019. ⟨dumas-02302493⟩

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