帝王切開で出産した女性の出産満足度と産後早期のうつ傾向との関連についての検討:―日本語版SMMSの信頼性・妥当性の検証を通して―  [in Japanese] Investigating the relationship between maternal satisfaction with the cesarean birth experience and early postpartum depressive tendencies:―Verifying the reliability and validity of the Japanese version of the SMMS―  [in Japanese]

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Author(s)

    • 鳥越 郁代 TORIGOE Ikuyo
    • 福岡県立大学大学院看護学研究科助産学領域 Department of Midwifery, Graduate School of Nursing, Fukuoka Prefectural University
    • 佐藤 香代 SATO Kayo
    • 国際医療福祉大学大学院助産学分野 Department of Midwifery, International University of Health and Welfare Graduate School

Abstract

<p><b>目 的</b></p><p>帝王切開(帝切)で出産した女性の出産満足度と産後早期のうつ傾向との関連を明らかすること,ならびにその出産満足度に影響を及ぼす要因について検討する。</p><p><b>対象と方法</b></p><p>A・B県の22の産科施設にて帝切で出産した褥婦362名を対象に,無記名自記式質問紙調査を実施し,回収は留め置き法と郵送法を用いた。質問紙は,母親の基本属性・帝切で出産した母親の出産満足度(日本語版SMMS)・産後のうつ傾向(EPDS)・自尊感情(自尊感情尺度日本語版)・母親の愛着(MAQ)より構成された。SMMS得点とEPDS得点ならびに属性との関連は,t検定・一元配置分散分析を用い,出産満足度に影響を及ぼす要因の検討は,重回帰分析を用い分析した。</p><p><b>結 果</b></p><p>回収率は83.1%(301名)で,そのうち294名(97.7%)を分析対象とした。帝切の分類は,予定帝切が207名(70.4%),緊急帝切87名(29.6%)で,出産満足群(SMMS得点≥147点)が247名(84.0%)を占めた。また出産満足群は,出産不満足群に比して有意にEPDS得点が低かった(p=0.003)。さらにSMMS得点に対する影響要因として,母親の愛着得点が選択された(p=0.001)。</p><p><b>結 論</b></p><p>出産満足群・不満足群の2群間において,EPDS得点に有意差が認められたことから,帝切での出産満足度と産後早期のうつ傾向には関連があることが示唆された。また,出産満足度に影響を及ぼす要因として母親の愛着が確認された。</p><p>以上のことから,助産師は,出産の振り返りを通して,帝切による出産に対する女性の認識を確認し,退院後も継続した支援を提供していくことが重要である。また帝切による出産の場合,遅れがちになる産後の早期母子接触・早期授乳を積極的に実施することが,出産満足度の向上につながると考えられる。</p>

<p><b>Objectives</b></p><p>The objectives of this study were: 1) to investigate the relationship between satisfaction with the birth experience and early postnatal depression among women who had had a cesarean delivery; and 2) to determine factors that influence maternal satisfaction with the birth experience.</p><p><b>Participants and Methods</b></p><p>We conducted a survey at 22 obstetrical institutions in A and B prefectures. The research participants were 362 postpartum women who had had a cesarean delivery. The questionnaires were self-administered. Completed questionnaires were returned by post or were left at the participating institutions. The survey items included: the basic attributes of the participating women; maternal satisfaction with the birth experience following cesarean delivery, as assessed by the Scales for Measuring Maternal Satisfaction (SMMS, Japanese version); the status of early postpartum depression, as evaluated by the Edinburgh Postnatal Depression Scale (EPDS); self-esteem, as measured by the Scale for Self-esteem (Japanese version); and maternal attachment, as measured by the Maternal Attachment Questionnaire (MAQ). The relationships between the SMMS score and EPDS score and/or the participants' basic attributes were analyzed using t-tests and one-way analysis of variance. Multiple regression analysis was used to investigate factors influencing maternal satisfaction with the birth experience.</p><p><b>Results</b></p><p>The overall response rate was 83.1% (301 of 362 women). Of those who completed the survey, 130 (44.2%) were primiparae with a first cesarean delivery, 139 (47.3%) were multiparae with two or more cesarean deliveries, and 25 (8.5%) were multiparae with a first cesarean delivery. There were more elective cesarean deliveries (70.4%, n=207) than emergency cesarean deliveries (29.6%, n=87). The mean SMMS score was 169.5. In total, 247 women (84.0%) were satisfied with the cesarean birth experience (the satisfied group; SMMS score ≥147). The mean EPDS score was 6.88. The mean EPDS score of the satisfied group was significantly lower than that of the group who were dissatisfied with the cesarean birth experience (the dissatisfied group; SMMS score ≤146) (p=0.003). A comparison of SMMS score by basic attributes showed no significant difference for all attributes, including cesarean delivery mode (planned or emergency). The MAQ score was the only factor identified as significantly influencing the SMMS score (p<0.001).</p><p><b>Conclusion</b></p><p>Our study suggests that there is a relationship between satisfaction and postnatal depression status among women who experience a cesarean birth. This was deducible from the significant difference in the EPDS scores registered by the two groups, i.e., the satisfied group and the dissatisfied group. We also found that maternal attachment was the only factor contributing to maternal satisfaction with the birth experience. In conclusion, it is important that midwives provide women the opportunity for reviewing the birth experience and continuous support after leaving hospital. In addition, earlier skin-to-skin contact and breastfeeding is recommended in the postpartum care for women experiencing cesarean births. These measures may lead to an improvement in maternal birth experience.</p>

Journal

  • Journal of Japan Academy of Midwifery

    Journal of Japan Academy of Midwifery 31(2), 140-152, 2017

    Japan Academy of Midwifery

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