母嬰親善政策為何變得不親善-以產婦為主體的產後照護研究

Abstract

自母嬰親善醫院認證計畫施行以來，常得到許多來自民眾或是專業人士的抨擊，指出實施時太強迫，未能考量產後護女身心的脆弱，然而在多年前，政府納入各方訴求，將此評鑑標準放寬，希望能改善醫療機構實施的情況，讓原本政策推行的美意能延續，與此同時，在110年開始進行國際愛嬰醫院的評鑑，顯現持續推動母乳哺育的決心。本研究探討台灣當代婦女產後哺乳經驗，檢視前述政策變化的影響，藉以提出建言。本研究亦納入第一線護理師的實務經驗，更加全面地探討從個人、資訊環境、機構措施、乃至整體政策，這些層面如何交互影響、共同形成讓女性感到不友善的產後環境。本研究為質性研究，主要以半結構式訪談法為主，田野調查及線上文本分析為輔，經由11位產後婦女、5位護理師的訪談，本研究發現，產婦普遍未接受完整的產前教育，缺乏關於分娩、產後哺乳的正確知識，以致當經驗與期望不符時產生失落感，並對護理師在執行的政策措施感到壓力，基層人力的缺乏，更讓產後婦女無法得到完整衛教及即時協助，是讓產後婦女感到不友善的主要因素。另外，在政府未積極監管的情況下，廠商推行配方奶的地點由醫院轉至媽媽教室，商業行銷的盛行，影響了整體社會看待生育的態度，過度的行銷包裝影響了父母的認知及判斷，以上的因素相互交織，塑造了當代的產後環境。基於上述，建議政府應規劃完整的產前教育，建立父母的正確認知，以及建立產後居家訪視機制，解決產婦居家育兒面臨的困境，讓整體的產後環境更為友善。

Since the implementation of the Mother-Baby Friendly Institute program(MBFI), it has faced criticism for being too coercive and not considering the fragility of postpartum women. The government then relaxed evaluation standards to improve implementation in healthcare institutions and maintain the policy's original intent. In 2021, evaluations of Baby-Friendly Hospital Initiative (BFHI) began, showing a continued commitment to promoting breastfeeding.This study explored contemporary breastfeeding experiences of postpartum women in Taiwan with an attempt to examining the influence of previous policy changes. This research also included insights from frontline nurses to explore how personal, informational, institutional, and policy factors interact to create a perceived unfriendly postpartum environment.This study used qualitative methods, including semi-structured interviews with 11 postpartum women and 5 nurses combined with participant observation. The study found a lack of comprehensive prenatal education and accurate knowledge about childbirth and breastfeeding led to a sense of loss when postnatal women confronted a gap between expectation and real experiences. The sense of loss was also reinforced by the pressure from nursing measures. The shortage of human power in care system also prevented women from receiving adequate education and assistance regarding breastfeeding, leading to the unfriendly environment. Additionally, due to inadequate government regulation, formula milk promotion has shifted from hospitals to maternal classes. This commercial marketing influences societal attitudes towards childbirth and affects parents' perceptions and judgments.The study suggests the government provide comprehensive prenatal education and establish a postpartum home visit system to support mothers and create a more friendly postpartum environment.