台灣婦女產後照護之變遷—以北部地區為例

The Postpartum Care Change among Taiwanese Women-With an Example of North Region

田聖芳(Sheng-Fang Tien)

指導教授 ： 余玉眉

國立臺灣大學/醫學院/護理學研究所/博士(2006年)

https://doi.org/10.6342/NTU.2006.02360

摘要

背景：產後照護俗稱坐月子，它相當影響婦女的生活，然而台灣目前尚無系統性研究此經驗的變化，及影響這變化的因素，因此本研究目的，為探討不同世代婦女照護的方式、接受照護的項目、接受照護的感受，剖析其中之變化，並分析形成此變遷的影響主要因素，俾能應用於臨床護理實務中，以利產後護理照護品質之提升。
方法：本研究是採用橫斷性設計（cross-sectional design）進行現象的探討。研究中特別以世代做為探討的分類，分為55歲以上世代(old cohort)、35-54歲世代(middle cohort)、25-34歲世代(young cohort)。以問卷一對一訪談的方式於某醫學中心台北院區婦產科、內科及小兒科門診之就診婦女或陪診婦女，進行量性資料收集。三個世代各訪問120人，合計360人的問卷資料，所得的問卷資料，則以SPSS10.0版軟體進行資料分析，分析方法包括描述性統計、卡方檢定、變異數分析、薛費氏法、費雪爾正確率考驗、邏輯斯迴歸分析、多元迴歸分析。
結果：(一)不同世代婦女產後照護方式有顯著差異，在55歲以上世代婦女以自己坐月子為主(51.8%)，35-54歲世代婦女是以婆婆(36.4%)或媽媽(31.0%)協助坐月子為主，並已開始出現選擇坐月子中心坐月子；25-34歲世代婦女仍是以婆婆(51.7%)或媽媽(33.8%)協助坐月子為主。至於生育史的坐月子方式組合型態，55歲以上世代婦女共有12種組合型態，35-54歲世代婦女共有12種組合型態，25-34歲世代婦共有7種組合型態。(二)不同世代婦女產後接受照護的項目之變化，1.飲食烹調層面：進食食物總數，不同世代具有顯著差異，進食食物類別對55歲以上世代婦女來說產後進食以麻油雞最多，而35-54歲世代婦女與25-34歲世代婦女進食的最多為蔬菜。在嚴禁碰觸食物種類總數，不同世代也具有顯著差異，55歲以上世代婦女與35-54歲世代婦女被禁止的食物種類最多為冷性食物如白菜；25-34歲世代婦女被禁止的食物種類最多為喝冷水。2.夜晚新生兒哭叫而需協助的情形，在不同世代亦有顯著差異，丈夫的協助對55歲以上世代婦女是最低，而夜晚需承擔新生兒哭叫的照顧，25-34歲世代婦女是比其他二個世代較低。3.心理支持事項有顯著差異，心理支持事項類別方面，三個世代婦女被支持最多的皆為主動幫忙。(三)三個世代婦女產後接受照護的感受，整體得分與接受照護滿意度的得分，是有不同的，以25-34歲世代婦女而言，對所接受到的感受之整體是較為滿意。至於接受照護的滿意度於25-34歲世代婦女，是呈現較正向的感受看法。(四)影響產後照護之因素：1.新生兒特性只有在35-54歲世代婦女，新生兒孫輩排行與照護方式有差異。照顧者背景，在55歲以上世代婦女，婆婆的職業與照護方式有差異。研究對象背景資料中，居住類型在三個世代影響是較明顯的，與婆婆同住選擇婆婆坐月子較高。2.新生兒特性只有在35-54歲世代婦女，新生兒性別與接受照護的項目有差異。照顧者背景只有在55歲以上世代婦女，婆婆的職業、健康狀況與接受照護的項目有差異。被照顧者與照顧者的關係與產後接受照護的項目，只有在35-54歲世代婦女，母親相處的關係與接受照護的項目有差異。研究對象背景資料中，家庭社經濟地位與產後接受照護的項目在三個世代的影響是較明顯。3.照顧者背景在三個世代的影響：55歲以上世代婦女，婆婆的健康狀況與接受照護的感受有差異；55歲以上世代婦女，母親的教育為小學，及35-54歲世代婦女，母親的教育為高中與接受照護的感受有差異。而被照顧者與照顧者關係對世代的影響，35-54歲世代婦女與25-34歲世代婦女，與婆婆或母親的關係較好，對產後接受照護的感受較為滿意。研究對象背景資料中，居住類型與接受照護的感受，在55歲以上世代婦女是有差異的；居住類型方面與自己的母親同住對接受照護的感受較為滿意，家庭社經地位方面過得較好者對產後接受照護的感受也較為滿意。
結論：本研究結果顯示，產後照護之變遷，隨著社會改變而有不同的結果，所以對未來產後照護的策略：1.重視婦女產後照護的看法，並強調身體的調養與心理的自在，2.男性參與於產後照護是社會趨勢，3.消費性坐月子服務的多元化，應加強品質標準的制定與監測，4.對日益增加的外籍配偶，其產後照護的適應，應給予積極性的關注與支持。

關鍵字

產後照護 ； 坐月子 ； 世代 ； 新生兒特性 ； 照顧者的背景

並列摘要

Background: The traditional Chinese rite of “Tso-Yueh-Tze,” also known as “doing the month” has influenced women in recovery during postnatal period. However, there is little systemic research exploring the differences of experiences following the rite in postpartum recovery and factors indicating the differences. The study aimed to explore the ways of this special postpartum care, items cared, thoughts and experiences postnatal women had in following this rite. The factors influencing the differences were studied as well. The study hopefully would propose some solutions used in promoting postpartum nursing care quality.

Method: The study employed a cross-sectional design. Cohort was considered as an important variable. In this study, we categorized our respondents into old cohort that is older than 55 years old, middle cohort, 35-54, and young cohort, 25-34. Personal interviews were conducted in one medical center in Taipei. Subjects were chosen from visitors and their companions in Obstetrics, Internal Medicine Clinic and Pediatrics Clinic in Outpatient Department. The quantitative data were collected. 120 from each cohort were interviewed. A total of 360 respondents were interviewed. Data was analyzed with SPSS10.0 software. Description statistics, chi-square test, ANOVA test, Scheffe’s test, Fisher’s exact test, logistic regression, and multiple regression were completed.

Results: (1) There was a significant difference in ways of postpartum care provided to women in different cohorts. Respondents (51.8%), older than 55, had cared themselves in doing the month. 35-54 year old respondents had their mothers (31.0%) or mother in laws (36.4%)provide care during “doing the month.” There were alternative choices when choosing to perform the “Tso-Yueh-Tze,” mainly postpartum care services from private service providers. 25-34 year old respondents had their mothers (33.8%) or mother in laws (51.7%)provide care. For the combined forms of “doing the month,” there were 12 kinds in the old cohort, 12 in middle cohort, and 7 in young cohort.
(2) The major difference in items cared in postpartum period was the food preparation. There was a significant difference in the total food categories in for each cohort. For the old cohort, they ate the sesame oil chicken the most, while the middle cohort and young cohort ate vegetables the most. The food forbidden in postpartum period was different in each cohort. For the old cohort and middle cohort, mainly the cold food was not allowed to eat. Cold water was the major thing that the young cohort should not drink. There was a significant difference found in caring newly born babies across the three cohorts. The husbands of women in the old cohort seldom helped care the babies. Among the three cohorts, the young one holds the least responsibility to care the babies at night. There was also a significant difference found in mental support. The most common support was family offering assistance.
(3) The study found differences in experiences of “Tso-Yueh-Tze,” and in the total score of satisfaction among three different cohorts. The young cohort has the highest score in overall satisfaction toward care. Overall they have satisfactory experiences in receiving care.
(4) Factors influenced postpartum care: a. The newborn babies’ characteristics caused differences in care only for the middle cohort. For the mother in laws who were older than 55, different occupations will influence the ways they provided care. Living conditions of respondents influenced the care providing. Respondents who live with their mother in laws would ask the mother in laws to take care of their Tso-Yueh-Tze. b. The newborn babies’ sex caused difference in items cared. Occupations, health status of mother in laws who were over 55 caused the difference in items cared. Relationship between caregivers and the cared women caused differences in total score of items cared only in the middle cohort due to their relationship to their mothers. Social economic status significantly influenced the total score of items cared in all the three cohorts. c. The influences from the caregivers in three cohorts: health conditions of mother in laws over 55 years old influenced the experiences of the postpartum women. Mothers of the old cohort were elementary school educated, and mothers of the middle cohort were high school educated. These factors influenced the experience of the postpartum women. The relationship the postpartum women had with mothers and mothers in laws influenced the experiences in all the three cohorts. Better relationship led to better experiences. There was a difference in experiences of postpartum care due to living environment in the old cohort. Living with mothers led to better experience. Better social status led to better experiences.
Conclusion: The study analyzed the differences in experiences of “Tso-Yueh-Tze” for postpartum women in a changing society. In the future, postpartum care should be emphasized both in terms of health recovery and mental well-being of the postpartum women, also. Male participation in helping following the rite is a trend. Consumptive services of “Tso-Yueh-Tze” by enterprises should be monitored to ensure quality. Besides, we should have more support and pay more attention to the postpartum care toward more and more foreign spouses immigrated to Taiwan.

並列關鍵字

postpartum care ； Tso-Yueh-Tze ； cohort ； newborn babies’ characteristics ； caregiver background

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