“會陰切開術”的當代爭議與其必要性的論述分析

Discourse Analysis of the Episiotomy Dispute in Taiwan's Obstetrics Practice

曾家琳(Chia-Lin Tseng) ； 張珏(Chueh Chang)

《女學學誌：婦女與性別研究》 21期 (2006/06) Pp. 47-112

https://doi.org/10.6255/JWGS.2006.21.47

摘要

自從1920年代美國產科醫界提出常規會陰切開術的優點後，這項手術逐漸為不同社會接受並採用；然而，歐美產科關於會陰切開術必要性的論述，在1990年代有了重大的轉變。會陰切開術的施行率，也因此被視為評估婦女生產照護品質的指標，以及產科醫師接受醫學新知改變行為的研究標的之一；但是，台灣的婦產科醫師並未受到“會陰切開術不應常規使用”論述轉變的影響。本研究將檢視台灣醫學論述中的會陰切開術，以分析產科界使用的脈絡。透過文獻分析法，分析近年醫學系共同筆記、醫界內部通訊、產科教科書以及期刊報章有關會陰切開術的討論內容；並在台北縣的某區域醫院產科，進行田野觀察。
對照國外產科知識的轉變，台灣因為單一助產專業、醫院生產的趨勢，以及台灣婦女自然產運動起步較晚，使得多數的產科醫師並沒有受到國外產科知識轉變的影響；也因為發展人工生殖高科技的產科研究取向，使得產科醫師忽視低科技的會陰保護技巧、和限制使用會陰切開術的論述。
在會陰切開術醫學論述的形成與轉變的歷史中，我們很清楚地看到現行醫療典範對於自然產的思考，是建立在醫療導向的邏輯之下。因此，為了讓醫療社群更能重視婦女健康，台灣需要建立產婦中心的新照護典範，並進行更多科學、以及產婦心理層面的評估。

關鍵字

會陰切開術 ； 自然產 ； 典範轉移 ； 醫學史 ； 醫學論述 ； 婦產科

並列摘要

The origins of medical discourses about the benefits of episiotomy can be traced back to the 1920s, when episiotomy slowly gained a wider acceptance in different societies. However, the 1990s saw a transformation of the debate, including the view that episiotomy should have been regarded as an important parameter for evaluating the quality of perinatal care. Yet, this concept has not been accepted by Taiwanese obstetricians. This paper therefore strives to shed some light on the evolution of episiotomy use in Taiwan through an analysis of the existing medical discourses.
In carrying out this research, the following methods and materials were utilized: archival analysis, examination of recent notes from medical school lectures, textual analysis of medical textbooks, newspapers, and public journals, review of communication in the obstetrics community, and a field study of a Taipei regional hospital.
Compared with some other countries, it appears that majority of Taiwanese obstetricians are not affected by the latest obstetric transformation, partly due to the dominance of male obstetricians, institutionalization of childbirth, and delayed childbirth movement. The ”high tech” values shared by a large number of physicians make them ignore the importance of restricted use of episiotomy, which is regarded as ”low tech,” but ”high art” procedure.
When reviewing the history of the formation and transformation of the episiotomy discourse, it is clear that the medical paradigm of childbirth continues to be medically centered. In sum, the obstetrical practice in Taiwan needs further scientific and psychosocial assessments, in order to allow for stronger focus of the medical community on women's health and well-being.

並列關鍵字

episiotomy ； childbirth ； obstetrics ； medical history ； medical discourse ； paradigm shift