快適な妊娠・出産を支援する基盤整備に関する研究 : 助産師を対象として  [in Japanese] A study to arrange a foundation supporting a comfortable pregnancy and delivery care : Based on questionnaire to midwives  [in Japanese]

妊娠, 出産における医療, 助産に関して, 実施したほうがよいか否か, 議論のある20項目について, 助産師の考え方や実態を明らかにすることを目的として, 日本助産学会, 日本母性衛生学会の名簿から無作為抽出した1, 807人を対象に自記式郵送調査を行った。その結果, 実施に賛成で重要性も高い事項は, 授乳時間を定めない, 塩分制限, 産婦の希望による分娩時の体位決定であり, 低い事項はルーチンな会陰切開, 会陰縫合を通常の縫合よりも1針多めに行う, 入院時洗腸などであった。80%以上の症例での実施割合が高い事項は, 砕石位での分娩, 分娩第2期に仰臥位にする, 授乳時間を定めない, 点滴をするであった。実施時の考慮事項では, 妊産婦や児の身体状況, 施設の方針, 妊産婦の希望の順であった。今後の方針をみると, 母乳育児や分娩体位などでは, 積極的に進めていくや減らしていきたいを支持し, 薬剤使用, 医療処置などでは, 現状維持を支持していた。以上から, 妊娠, 出産における医療, 助産の実践に関しては, 助産師の立場からのエビデンスの蓄積と, それに基づいた適切な実施を検討していくことの必要性が示唆された。

We sent questionnaires to 1807 midwives, selected from the member lists of Japan Academy of Midwifery and Japan Society of Maternal Health by simple random sampling, to know the midwife's opinion and the present state on twenty items. Regarding the medical care and midwifery for pregnancy and delivery, these items are under discussion now, if they are right to do or not. The replies to the questionnaires show the following points. The items approved and regarded to be highly essential to do are ; not to set a fixed breastfeeding time, to explain salt restriction, to choose a body position by a pregnant woman and so on. On the contrary the items regarded as less important are ; routinely executed episiotomy, one more stitch suturing of the perineal area, enema at the time of hospitalization and others. Items showed high practicing rate on 80 % samples are delivery at the lithotomy position, to put a pregnant woman in a lying position at the second stage of labor, not to fix a breastfeeding time and the intravenous drip. The items well considered in executing works are in the order of to check the physical condition of pregnant women and babies, to follow the principle of the maternity home, to attend to the pregnant women's desires. Concerning the course to be taken hereafter, they positively support to increase to explain about the breastfeeding and the position of labor, but suggest to keep the present level on the usage of medicine and the medical treatment. From this study on the practice of medical treatment and midwifery for pregnancy and delivery, the necessity is showed to accumulate evidences from the viewpoint of midwives and to consider the effectual execution of them.