不再「傻傻的」孕婦：戰後以來台灣產前檢查醫療化的發展與影響

From Little Worries to Big Anxieties: The Medicalization of Prenantal Examination and Women's Changing Experience of Pregnancy in Taiwan, 1945-2006

陳家萱(Chia-Hsuan Chen)

指導教授 ： 王秀雲

高雄醫學大學/護理學院/性別研究所/碩士(2007年)

https://doi.org/10.6832/KMU.2007.00069

摘要

本論文以歷史觀點討論戰後至今(1945~2007年)產前檢查的發展與改變，並企圖透過孕婦自身的經驗，探討不同世代孕婦所面臨的議題，包括懷孕經驗、醫療技術發展，產檢意義、社會權力關係與脈絡的轉變，以及其中的性別政治。

本研究發現，數十年來，產檢從對產婦的產前照護走向醫療化、精密化且遺傳化，關注對象也從母親轉變為胎兒，並開始強調胎兒的質，譬如胎兒的生命權。除此，產檢的醫療化也造成了醫生與孕婦間關係的轉變，不僅帶來兩者之間的焦慮，也引發母親與嬰兒主體權利的緊張關係。上述關係的轉變，除醫療化之外，應是各種社會權力，如風險論述、高齡產婦迷思、健康營養規訓、投資概念等，交互作用的結果。

本研究也觸及陪伴產檢、從事產檢，以及被產檢的胎兒三部份的性別政治。懷孕生產由純然的女性經驗轉變為男人可以介入的事，包括醫療人員和孕婦的伴侶。產檢醫療化與生產醫療化是同步的，在此過程，醫生逐漸取代產婆的位置，也與孕婦間產生了不同於產婆的緊張關係。而伴侶的介入則包含了婚姻模式的轉變以及醫療系統的配合兩種因素。至於被產檢的胎兒，本研究認為，生男孩的壓力依舊存在，生男生女的擔憂因為產前檢查的發展得以提前開始，而生男生女的選擇，則連結了性別氣質的既定印象。

關鍵字

產前檢查 ； 醫療化 ； 孕婦 ； 焦慮 ； 性別政治

並列摘要

Drawing on 24 women’s experiences with pregnancy, this thesis examines the history of prenatal care in Taiwan in the period between 1945 and 2007. By doing so, this thesis aims to investigate such issues as the changing experiences of pregnancy of different generations, the development of medical technology, the transformation of the meaning of prenatal examinations, and the gender politics of these developments.

The focus of prenatal examinations has shifted from providing prenatal care for the mother to probing the status of the fetus. Beginning in the 1970s, pregancy itself has also been highly medicalized. As a result, the fetus has become the object of medicalization, and its personhood and rights have emerged in order that it assumes the potential sick role. These developments have brought about a set of new problems. First, increasingly women experience more anxiety than their counterparts in the previous generations. Women today are more likely to be haunted by many potential abnormalities of the fetus. Secondly, the confidence in medical progress has also raised the expection on the part of the pregnant woman, and yet physicians in general are reluctant to make promises lest there be any dispute in the future, which in turn creats tensions and anxiety.

I also analyze the gender politics regarding the three main actors who are most important for the pregnant woman--, the partner, the physician and the fetus. Pregnancy and child birth used to be regarded as exclusively women’s work, but gradually male participants, including physicians and partners/husbands have come involved, though starting at different time periods and taking different roles. In the process, the midwife is replaced by the OB/GYN doctor, who is often a man. The participation of the spouse is a result of the changing practice of marriage; couples now regard pregnancy and reproduction as something to be shared by the two partners. Husbands now often accompany their wives to their routine prenatal checkups to show that they are responsible and considerate. As for the unborn, this research finds that the pressure to have at least a baby boy still exists, the anxiety over the sex of the baby has shown earlier during pregnancy because of the available prenatal diagnostic technology is now able to determine the sex of the fetus much earlier than before.

並列關鍵字

prenatal examination ； medicalization ； pregnant women ； anxiety ； gender politics

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