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  • 學位論文

割捨與維護孕育的經驗歷程- 多胞胎孕婦接受減胎手術的生活經驗與因應行為

The Process of Forsaking and Maintaining Pregnancy- Lived Experience and Coping Behaviors of Women with Multifetal Pregnancies and Fetal Reduction

指導教授 : 蘇燦煮

摘要


不孕夫婦在生殖科技的進步中,增加了懷孕的機會,卻也使多胞胎妊娠的發生率攀升,然而,多胞胎妊娠卻會增加母體及胎兒的合併症,醫療上建議減胎。另外,現今醫療上的進步,為了避免生下染色體異常的胎兒,會於減胎手術前,建議先做絨毛採檢,篩選出染色體異常的胚胎作為減胎的對象。面對此減胎手術 ,多胞胎孕婦會陷入必須接受減胎手術,但內心卻又充滿矛盾、不捨、罪惡與恐懼,需要醫護人員的協助。本研究目的為深入探討接受體外受精治療後受孕之多胞胎孕婦,其面對及接受減胎手術期間,為了達到順利進行與完成生育的生活經驗與因應行為。 本研究採質性研究設計,以田野研究法進行。研究情境為台北市一所婦產專 科診所,遺傳諮詢與診斷為其主要業務之一。研究對象為接受體外受精治療後受 孕之多胞胎孕婦,共10位。研究者以研究對象之主護護理師身分,一面提供護 理照護,同時以觀察者即參與者之角色,藉由觀察及訪談收集資料,於每位研究 對象第一次接受減胎諮詢到減胎後第五週止,共5次面對面訪談及8次電話訪談 ,並將訪談內容以文字記錄。資料採現象學解釋性分析,包括三個策略:主題分 析、範例分析及典範案例分析。 本研究結果,由資料歸納出多胞胎孕婦接受減胎手術的生活經驗之主題為割捨與維護孕育的歷程。而依據進行減胎手術的時序,歸類為三個階段,及生活經驗之類目,分別為:(一)減胎手術前階段:陷入對多胎妊娠一再確定的脅迫感、陷入對胚胎生命取捨的迷惘與衝突、及減胎抉擇後的內心抑鬱與糾結。(二)進行減胎手術階段:面臨減胎手術的惶恐與擔憂、面臨家人不斷質疑與責難,愈益擔憂與無助、及獨自承受減胎手術的身心苦楚。(三)減胎手術後階段:原有身體不適的解脫、陷入失去部分胎兒的哀愁、術後身體不適,順利孕育顯疑慮、及滿懷母情,踏入孕育歷程的常軌。另外,由資料歸納出研究對象在這些生活經驗的歷程中,採取的行為包括:尋求資訊,以確實掌握相關訊息、尋求名醫,以確保自身及胎兒安全、對抗制衡,以取得內心的平衡、強化自我,以增強內心的力量、操縱自我,以確保順利孕育。 本研究結果可供醫療政策上之參考,並可提供臨床上對多胞胎孕婦接受減胎的護理照護之依據,協助其渡過失去部分胎兒的哀傷、自責及繼續孕育之路。

並列摘要


Because of the progress of the reproduction techniques, the infertile problems can be solved in recent years. On the other hand, the incidence of multiple gestations has been increasing in recent years. As a result that the multiple gestations will cause the medical risk of fetus(es) and mothers, fetal reductions are recommended. The fetus to be reduced used to be selected on technical grounds. Now, prenatal diagnosis by chorionic villus sampling on the fetus (es) before fetal reduction has been offered. Fetal reduction should be guided by the results of the genetic analyses. The women with multiple pregnancies when facing with fetal reduction would experience conflict, reluctance, guilt, and fear. Understanding their lived experience is essential to provide appropriate care. The purpose of this research, therefore, was to explore the lived experience of women with multiple pregnancies when undergoing fetal reductions. This study adopted qualitative research design and was conducted by the field method. The setting was in one of the obstetrics, gynecology clinics in Taipei city. This clinic also offered genetic counseling and diagnosis. Ten women were chosen as the study samples by purposive sampling that became multifetal pregnant after in vitro fertilization treatment. As a primary care nurse, the researcher took care of the subject, and collected data. The data were collected between first consult to receiving fetal reduction five weeks later. Each subject took five face-to-face interviews and eight telephone interviews. The collected data were written as a narrative record. The data were analyzed based on the interpretive research strategies of phenomenology. According to the results of this study, the main theme of the lived experience of subjects was “the process of forsaking and maintaining pregnancy”. It was put into two categories-the lived experience and coping behaviors. The lived experience comprised three stages: before fetal reduction, undergoing fetal reduction, and after fetal reduction. First, the lived experience before fetal reduction included: 1) The threatened feeling in reconfirming the fact of multiple pregnancy; 2) Difficulty in deciding whether to receive fetal reduction or not; 3) The depressed and complicated feeling when already decide to receive fetal reduction. Second, the lived experience when undergoing fetal reduction included: 1) The frightened and worried feeling when facing with the procedure of fetal reduction, 2) Increasing worried and helpless feeling when confronting doubts and blame from other family members; 3) Bearing the pain from fetal reduction physically and mentally alone. And finally, the lived experience after fetal reduction included: 1) Relieving oneself of the physical discomfort. 2) The sorrow caused by losing some fetuses; 3) Doubt about whether safe pregnancy and delivery or not when physical discomfort appears. 4) Filled with maternicity and back to normal course of pregnancy. Also, the results showed that five coping behaviors were used in order to pass the lived experience, The results can be applied as a reference for clinical nursing staff.

參考文獻


蘇燦煮、陳月枝、楊友仕(2000)•接受人工生殖治療期間之身體症狀•台灣醫學,5(2),145-152。
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陳淑溫(2000)•接受人工生殖初次懷孕婦女於第一孕期之監測及維護行為•護理研究,8(3),289-299。
蘇燦煮、楊雅玲、鄧素文(1997b)•接受生殖科技治療婦女於確定受孕時之經驗感受與調適歷程•護理研究,5(2),104-114。
李從業(1994)•正常和曾有不孕病史的懷孕婦女親子連結之比較•護理研究,2(1),67-77。

被引用紀錄


余靜如(2015)。臺灣多胞胎妊娠婦女於接受減胎術之決策歷程〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2015.01228
蔡淑惠(2007)。歷經非選擇性終止妊娠之婦女的哀傷與創傷後反應及其相關因素〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2007.03141

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