生產害怕、社會支持及生產結果之探討

The relationship between Fear of Childbirth, Social Support, and Birth Outcomes

塗惠絨(Huei-Rong Tu)

指導教授 ： 郭淑瑜

臺北醫學大學/護理學院/護理學系碩士暨碩士在職專班/碩士(2016年)

摘要

生產害怕普遍存在於懷孕婦女，不僅影響女性的懷孕調適，且容易增加不良的生產結果；而其配偶、親友及醫護人員的支持對懷孕過程及待產階段是重要的。目前對台灣婦女生產害怕與社會支持的瞭解相當有限，故本研究目的為探討台北地區懷孕婦女生產害怕、社會支持與生產結果的狀況與其關聯性。本研究採前瞻性世代研究設計，收集懷孕婦女的產前資料並追蹤其生產結果。研究問卷包括: 生產害怕量表、社會支持量表、醫護支持量表與生產結果量表及基本資料量表。使用卡方檢定、獨立性t檢定與迴歸等方法進行資料分析。
在北部某教學醫院的產科門診共收案159位懷孕婦女，其平均年齡為33.4歲 (標準差4.7歲)，59.7%為初產婦。生產害怕平均分數為66.6分 (標準差22.3)，婦女表示最害怕的題項為生產的疼痛，而具高度害怕 (≧66分)的女性佔多數 (50.3%)。社會支持平均分數為5.6分 (標準差0.8)，76.1%的婦女具有高度社會支持，而醫護支持平均分數為59.6 (標準差11.5)分，多數婦女具有低度醫護支持 (49.7%)。在生產結果部份，47.2%的婦女採陰道生產，51.6%的婦女有使用麻醉藥物；新生兒出生體重平均為3067克 (標準差439.5克)。邏輯斯迴歸分析指出，年齡≦29歲的婦女容易有生產害怕 (adjusted odd ratio，aOR: 9.98，95% confidence interval CI: 1.57–63.47)；自覺健康狀況好的婦女較少有生產害怕 (aOR: 0.25，95% CI: 0.11–0.58)；缺乏社會支持及重要他人支持的婦女則易有生產害怕的機會 (aOR: 4.50–5.20，95% CI: 1.45–15.35)。有中低度生產害怕的婦女在待產時較少使用麻醉藥物 (aOR: 0.40，95% CI: 0.19–0.83)。具高度社會支持的婦女，其新生兒第5分鐘Apgar score會下降0.35分 (B=-0.35，p=0.01)。
藉此研究我們發現台灣懷孕婦女具有高度生產害怕，而缺乏社會支持是生產害怕的重要相關因子，且生產害怕的婦女較常使用麻醉藥物，建議未來須持續性評估產前婦女生產害怕與社會支持的變化，以提供婦女完善的周產期照護及降低不良生產結果。

關鍵字: 生產、害怕、社會支持、生產結果、懷孕婦女、世代研究

關鍵字

生產；害怕；社會支持；生產結果；懷孕婦女；世代研究

並列摘要

Fear of childbirth is common in the pregnant women. It affects the adjustment of pregnancy women, and links to adverse birth outcomes. The support form women’s partner, relatives, friends and medical personnels is very important during perinatal period. There was eimited study on childbirth fear and social suppot in Taiwan. The purpose of this study was to investigate the pregnant women’s fear of childbirth, social support and birth outcomes. In this study, a prospective cohort study was used to collect the information of prenatal women, and followed their birth outcomes. The questionnaires uesd included The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), Multidimensional Scale of Perceived Social Support (MSPSS), and Quality from the Patient’s Perspective (QPP). We performed the chi-square test, independent t-test and regression analysis for the data analysis.
A total of 159 pregnant women were recruited in a northern maternity clinic of the teaching hospital. The average age of participants was 33.4 years old (standard deviation, SD 4.7), 59.7% of them were the primipara. The mean score of W-DEQ average score was 66.6 (SD 22.3), in which the "very painful" item rated as the highest fear item. 50.3% of women have the high fear. The mean score of social support was 5.6 (SD 0.8), 76.1% of women with a high degree of social support. The average score of the medical and nursing support was 59.6 (SD 11.5), 49.7% of women have the low degree of medical and nursing support. For the birth outcomes, 47.2% of women had vaginal delivery, 51.6% of them used the narcotic medications. The mean of newborn's birth weight was 3067g (SD 439.5g). The result of Logistic regression analysis indicated that younger women (≦29 years) was significantly associated with fear of childbirth (adjusted odd ratio, aOR: 9.98，95% confidence interval CI: 1.57–63.47). The women with good self-rated health (aOR: 0.25, 95% CI: 0.11–0.58) were less likely to have fear of childbirth, women with poor social support and significant others support tended to have more fear of childbirth. (aOR: 4.50–5.20, 95% CI: 1.45–15.35). Women who experienced having a low level of fear were less likely to use the narcotic medications (aOR: 0.40, 95% CI: 0.19–0.83). Women who had high level of social support, the Apgar score 5th minutes of newborn decreased 0.35 (B=-0.35,p=0.01).
In this study, we can found that the pregnant women generally have fear of childbirth in Taiwan, and lack of social support was associated with high fear. The women who had fear of childbirth tended to use the narcotic medications during labor. The continuous assessment the antenatal women's fear and social support is vatal to provide better perinatal care and reduce adverse birth outcomes.

Key words: fear, childbirth, social support, birth outcomes,
pregnant women, cohort study

並列關鍵字

fear；childbirth；social support；birth outcomes

參考文獻

中文部份

鄭綉絨, & 陳彰惠. (2001). 產褥期母親的關注與社會支持. 護理研究, 9(3), 322-332.

國民健康署（2014）．103年出生通報年報. 取自http://www.hpa.gov.tw/Bhpnet/Web/HealthTopic/Topic.aspx?id=201109200006

英文部份

Adams, S. S., Eberhard-Gran,M., Eskild,A. (2012). Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG: An International Journal of Obstetrics and Gynaecology, 119(10), 1238-1246. doi: 10.1111/j.1471-0528.2012.03433.x