出産体験の決定因子 : 出産体験を高める要因は何か?  [in Japanese] The determinants of childbirth experiences : What are the factors to improve the birth experience?  [in Japanese]

【目的】本研究の目的は,出産体験を高める決定因子を明らかにすることである。【方法】本研究は2002年5月〜2003年8月に,5つの施設(4助産所,1産院)で分娩をした女性を対象としたコホート研究のデータから,条件を満たした1,215人のベースライン調査のデータを用いた。データは出産数日後に,調査員による診療録からの転記,および質問票を用いた直接面接によって収集された。出産体験と妊産婦ケアや産科医療介入,妊娠中の状態などの関連について,二変量解析および多変量解析を行った。【結果】会陰切開などの産科医療介入を受けた女性は,受けていない女性と比べて出産体験が低かった。"人間的なケア"や女性が安心できる分娩環境,妊娠期から女性がよりよい出産に向けて努めることなどが,出産体験を高めることが明らかになった。【考察】本研究によって,根拠に基づいた適切なケアが提供されるだけでなく,女性自身の妊娠期からの健康に対する意識や,医療従事者と女性の信頼関係を構築することも出産体験を高める決定因子であることが示された。

Objective: The purpose of this study was to investigate the determinants which enrich childbirth experiences. Method: All women who gave birth at five study centers (four birthing homes and one maternity hospital) from May 2002 to August 2003 were asked to participate in the cohort study. From the data of cohort study, 1,215 eligible women were included for analyses in this study. Analysis was conducted using a baseline survey. The data were collected via structured interviews and transcription from medical records a few days after childbirth. Bivariate and multivariate analyses were conducted to investigate the relationship between childbirth experiences and antenatal care, medical intervention, behavior during gestation and so on. Results: Women who had some medical intervention such as episiotomy reported significantly lower childbirth experiences than those who had nothing. It showed that "humanized maternity care", an environment for childbirth where women felt comfortable and women's trying to keep good condition in pregnancy made childbirth experiences enriched. Conclusion: This study revealed that the determinants of enriching childbirth experiences were not only appropriate evidence-based-care but also women's awareness for their health and healthy lifestyle and establishing a trust relationship between women and caregivers.