生產照護措施與母乳哺育經驗的
質量交叉研究

本研究目的在瞭解育齡女性對哺乳之預期與實際體驗，以及檢視生產照護措施對母乳哺育的影響。採深度訪談及問卷調查的混合研究。12位低危險性自然懷孕且願意受訪之女性，於懷孕35週、生產住院期間、產後兩週內、產後6-8週，接受至少四次深度訪談，有51份訪談文本。以內容分析法，歸納生產照護措施與母乳哺育對女性之意義涵蓋「自我調整」與「環境牽制」兩大主軸。女性體驗母乳哺育的自我調整歷程，包括「好母親的使命與壓力」及「對身體的驚喜與擔憂」兩個面向。生產照護措施對母乳哺育的外在牽制則包含，「支持力量」及「干擾情境」兩個範疇。依據文獻、研究員實務經驗與訪談結果而自擬量性問卷；內容包括母乳哺育評估表、生產照護措施評量、人口學資料及開放式問題等四部分。於住院期間及產後6-8週，進行兩次問卷調查；分別在宜蘭、高雄、及花蓮4家通過母嬰親善認證的醫院實施，回收有效問卷分別為住院期間190份及產後6-8週有210份。結果發現，母乳哺育態度量表及接受親善生產照護措施得分愈高，愈傾向選擇母乳為主餵食方式；愈擔心奶水不足者，愈傾向選擇非母乳為主的餵食方式。自覺生產照護經驗對母乳哺育感受量表的四個分量表中，以「醫療介入措施」得分最高，「個案自主中心」得分最低。決定是否採用母乳為主餵食方式的預測因子，在住院期間包括：母乳哺育態度量表得分、待產時刮除陰毛及24小時親子同室；產後6-8週為:擔心奶水不足、向護理人員諮詢困擾及依嬰兒需求餵食。對實務的建議包括：強化先生與醫師在生產與餵奶過程的角色、積極規劃與推動母親友善生產照護措施、增加一對一諮詢服務、呼籲親子同室中家庭責任及破除嬰兒哭鬧與奶水不足之聯結、督促政府盡速建構完整母乳支持網絡，包括：推動友善職場、爭取母乳諮詢門診服務納入健保給付等。本研究傳承哺乳女性的在地經驗，提供臨床實務工作者掌握生產與母乳哺育對女性的意義，進一步釐清當前醫療模式生產環境中干擾哺乳的相關因素，做為政府決策單位發展在地母乳推廣計畫的參考。

關鍵字

生產照護措施；母乳為主餵食方式；母嬰親善醫院十措施；母親友善生產照護

並列摘要

The goals of this prospective study were to understand the expectation and experiences of women’s viewpoints about birth and breastfeeding, and to identify the factors influencing birthing and breastfeeding practices in Taiwan. Both in-depth interviews and questionnaires were separately used in this two-part mixed-methods study. The interviews were conducted with a total of twelve women who were in normal singleton pregnancy and willing to be interviewed four times: at third trimester, during their in-hospital stay, around 14 days postpartum, and 6-8 weeks postpartum. Content analysis was used for interviews data. The collected data formed themes and showed those women’s experiences on birth and breastfeeding could be assigned to two groups: (1) adjusting to, or (2) in conflict with, bodily changes, physical discomfort, breastfeeding problems; and rigid policies. The self-designed questionnaire was based on literature review, researcher’s clinical experiences, and qualitative findings. The instrument was a four-part questionnaire including queries on breastfeeding and birthing experiences, and demographics data, along with open-ended questions. In total, 190 and 210 responses to the questionnaires were collected during the two stages: in-hospital stay, and 6-8 weeks postpartum. These replies were obtained from maternity clients at four Baby Friendly Hospitals. Results showed that higher scores on both the breastfeeding attitude scale and the number of clients-received items related to mother-baby friendly careswere significantly related to an occurrence of full breastfeeding. A concern about having not enough milk was significantly related to differences in occurrence between full breastfeeding and non-full breastfeeding. The scale of self-awareness about influences of mother-baby friendly interventions on breastfeeding levels was divided into four sub-scales, in which the highest total score was BFHI-Accreditation-Indicators group; the lowest total score was sensation-led-interventions group. The predictors of full breastfeeding during hospital stay period included: breastfeeding attitude score, shaving of all or some of the pubic hair, 24 hours rooming in during hospital stay, and without concerns about not having enough milk. And during 6-8 weeks postpartum were a concern about having not enough milk, counseling by nurses, and by demend feeding. Based on the results, recommendations include: more emphasis on the role of paternal/husband and obstetricians’ involvement in breastfeeding issues, promotion of mother-friendly care, implementing one-to-one consultant care, highlighting the families’ responsibilities while rooming-in, breaking the perceived link between babies’ crying and not receiving enough milk. In addition, to encourage government to construct a solid support network which covering friendly workplaces and including IBCLC clinical services payments under NHS. The results provide a greater understanding and insight regarding the breastfeeding experiences of Taiwanese women, and can help in providing more sensitive care with respect to personal cognitive issues of nursing women. In addition, it could lend support to revisions in government policies on these matters.