經歷死產婦女之生命歷程：尋求安身立命

經歷死產被認為是較難調適的失落類型，因為失落的發生是突然的、大多數未看到孩子以進行哀悼、沒有可以分享的回憶或生活經驗、缺乏社會在意義上的認可以及缺少如同其他失落事件發生時可獲得的情緒與社會支持，甚至可能遭受周遭迴避與負向的態度。文獻上論及死產是婦女的重大失落已有20年以上的歷史，但是國內的研究困境在於本土文化並不鼓勵經歷死產婦女談論其經驗及感受，造成健康專業人員對死產婦女經驗的忽視與不瞭解。本研究目的旨在描述台灣婦女經歷死產的經驗歷程，並建構能夠解釋台灣死產婦女經驗歷程的理論。運用紮根理論的研究方法，收案的個案數以達到理論飽和為原則，最後完成與21位經歷死產婦女的深度訪談，每位研究參與者訪談次數以資料飽和為考量，本研究每位研究參與者訪談次數為一至三次，所有訪談內容在徵得研究參與者同意下予以錄音，於訪談結束後逐字謄寫成文本。訪談資料經由持續比較分析確認出本研究的核心概念，發現婦女在經歷死產後的核心生活脈絡是積極塑造逝去孩子的生命繼續存在的信念，命名為『尋求安身立命』。『尋求安身立命』的過程可包含四個階段，分別是階段一：母親角色的幻滅、階段二：生命的幽谷、階段三：尋求生命的出口，以及階段四：身心得以安頓。本研究參與者『尋求安身立命』的前置條件包含她們發生死產前已有的子女數、懷孕週數與築巢行為、宗教信仰以及是否有工作以轉移注意力。另外，『尋求安身立命』的中介條件涵蓋促進因子或是障礙因子，包括時間的效應、丈夫的支持以及社會價值信念。本研究結果不僅發展一個紮根於資料的本質理論，同時能夠作為未來臨床護理介入計畫的基礎。

關鍵字

死產；哀傷；生命歷程；紮根理論

並列摘要

Stillbirth has been considered difficult to cope with, as the death is unexpected, the majority have not seen the child to mourn for, no memories or shared life experiences, and often lack of recognition for the significance of such loss by the society. Stillbirth was acknowledged as a major loss for women in the late 20 years. Grief following the loss is common human experience and viewed as a health issue. However, empirical research related to this topic is rare in Taiwan. Hence, the purpose of this study is to describe the process of Taiwanese women’s experiences of stillbirth and constructs a theory that can explain those women’s experiences. In order to understand the psychosocial process of women encountering stillbirth, a grounded theory method was used. Based on theoretical saturation, a purposive sample of 21 women was recruited in the study. The core category and related categories were identified using the constant comparative process. The core category of “searching for settling down and moving on with life” emerged, to which each substantive category relates. The core category comprises four stages: shattered maternal role, falling into a deep valley of life, searching a vent for life, and finding peace for body and mind. The antecedent conditions is a prerequisite for the healing process, which consists of the number of living children, gestational point of loss, religious belief, and whether employment outside the home. The intervening conditions contains what facilitated or hindered the process and consists of time since the loss, perceiving support from the mates, and social value and belief. Finally, the findings of this study not only generate a substantive theory of psychosocial process in stillbirth women, but also as the basis for future clinical nursing intervention.