施行剖腹產後自然生產的產婦之經驗
The Experiences of Multipara Who Chose to Undergo Vaginal Birth after Cesarean
摘要
剖腹產率的增加雖然是全世界共同的一個現象，但台灣一直以來居高不下的剖腹產率，實在值得加以重視，而推行剖腹產後自然生產(vaginal birth after cesarean，VBAC)是降低剖腹產率的方式之一，更是未來產科醫療照護體系中應加以重視的新趨勢。本研究的目的包括：㈠探討影響婦女接受VBAC之決策因素；㈡探討成功施行VBAC產婦的生產經驗。本研究採現象學研究法。研究對象為十位曾經施行剖腹產後自然生產之產婦，以低結構的方式於產後1-2天進行訪談，每位研究對象訪談一次，每次訪談時間約30-50分鐘，所有訪談的內容均予以錄音，並以Giorgi的現象學方法分析所收集到的資料。研究結果萃取出的主要概念分為兩個部分。在「影響婦女施行VBAC的決策因素」中，萃取出六個主要的概念，包括：「生產方式利弊的衡量」、「過去的生產經驗」、「生育及為人母的個人信念」、「新生兒的自然出生時間」、「醫師的建議」及「尋求資訊」；在「接受VBAC婦女的生產經驗」中，則萃取出五個主要的概念，包括：「無法預期的產程進展」、「出乎意料之外的疼痛」、「子宮破裂的恐懼」、「比較剖腹產及自然產間的差異」及「對選擇自然生產方式的自我肯定」。依據本研究之結果，可提供護理人員依照個案的需求設計適當的諮詢或衛教方案。
並列摘要
Although cesarean section (CS) rates are rising in many countries around the world, the rate in Taiwan has been, and remains, comparatively high for a very long time. This condition is worthy of note, vaginal birth after cesarean (VBAC), one way to decrease CS rates, appears to be an increasingly popular trend in the future obstetric medical care system. The purpose of this phenomenological research was to explore the decision-making factors and the childbirth experiences of multipara who underwent VBAC. Ten women consented to participate in this research. Participants were interviewed in a loosely-structured way one to two days after delivery. Every participant was interviewed one time and every interview took between 30 and 50 minutes. Each interview was tape-recorded in its entirety. Giorgi's qualitative method of phenomenology was used to analyze collected data. The finding of this research can be divided into two parts. In terms of decision-making factors for multipara who chose to undergo VBAC, we identified six essential concepts. These included pondering the advantages and disadvantages of different delivery methods; the influence of past delivery experience; personal beliefs about childbirth and motherhood; the timing of natural delivery of the newborn; doctor recommendations; and seeking information. In terms of the childbirth experiences of multipara who underwent VBAC, we identified the following five essential concepts: unpredictable delivery process; unexpected pain; fear of uterine rupture; comparisons with cesarean section and normal spontaneous delivery; and self confidence in choosing VBAC. The results of this study will enable nurses to design appropriate counseling and educational programs that better address client needs.
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