比較年輕及高齡初產婦產後初期之母育信心與社會支持

Abstract

國內目前生育年紀約34-35歲，其中35歲以上高齡產婦約佔5%左右，高齡婦女在孕產過程中均較一般婦女有較高合併症及剖腹產率，其照顧需求亦應與一般婦女有別，本研究期能暸解年輕及高齡初產婦在母育信心與社會支持的差異，並暸解不同年齡別產婦之照護需求，進而提高周產期婦女之照護品質。 本研究採問卷調查法。以立意取樣方式收集年輕組56人及高齡組42人。研究工具為自擬之產婦基本資料、中文版母育信心量表及社會支持量表。資料收集分為二次，第一次為產後3-5天，地點為產後病房；第二次為產後14天，地點為產婦坐月子所在處。資料分析是以SPSS15.0版套裝軟體進行分析，以描述性統計描述個案之基本資料、母育信心及社會支持分布情形，再以Mamm-Whitney Test進行組間之比較，並以廣義線性模式（Generalized Estimation Equation,簡稱GEE)統計方法確立相關因素。 年輕組平均年齡為28.02±1.40歲，高齡組為36.57±1.7歲。產婦之母育信心在產後初期無年齡別間之差異。母育信心隨產後日數增加有上升趨勢，但此變化無統計上之差異。社會支持分為「需要程度」「協助情形」及「足夠程度」等三層面。社會支持「需要程度」在產後初期無年齡別間之差異，且隨產後日數增加其變化情形不大。社會支持「協助情形」在產後初期有年齡別間之差異，高齡組所獲得之協助情形較年輕組差，但隨著產後日數增加兩組婦女自覺所得到的「協助情形」有增加，但未達顯著差異。社會支持「足夠程度」在產後初期有年齡別間差異，高齡組主觀感受到自己得到之社會支持「足夠程度」較年輕組差，但隨產後日數增加，社會支持「足夠程度」其變化情形不大。在調整時間、年齡組別效應之後，以GEE分析母育信心與社會支持之相關性，高齡產婦的母育信心與其社會支持「需要程度」層面呈負相關（-0.228 p=0.002）低齡組之母育信心則與社會支持「協助程度」呈負相關（-0.168 p=0.049）。調整年齡及時間變項之後，以GEE分析母育信心之相關因素有家庭總收入及社會支持「需要程度」；社會支持「需要程度」層面之相關因素有教育程度及產前參加教育課程；社會支持「足夠程度」層面之相關因素有坐月子期間哺餵方式。 針對本研究之結果，建議應瞭解兩組年齡不同特質產後婦女之母育信心與社會支持，更能增加對產後初期初產婦之適切照顧與服務品質。

Currently, the childbearing age of women in Taiwan is about 34-35 years old which comprises 5% of elder primiparas aged over 35. Elder primiparas are more likely to develop complications and have a higher rate of caesarean section than other women; thus, their care needs also differ. This study aimed at studying differences in younger and elder primiparas’ maternal confidence and social support and the age-specific maternity care needs in order to improve quality care for women in the perinatal period. This study adopts the questionnaire survey method. Through purposive sampling, 56 study objects in the younger primipara group and 42 in the elder primipara group were collected. The research tools used include the basic information of primiparas, maternal confidence scales (Chinese version), and social support scales. The data was collected in two sessions including: (1) data of 3-5 days postpartum in the postnatal ward; and (2) data of 14 days postpartum in a location for postnatal care confinement. The SPSS15.0 software package was used for the data analysis in which the basic information, maternal confidence, and social support distribution were described through descriptive statistics. Then, the comparison between the younger and elder group was conducted through the Mamm-Whitney Test and the relevant influential factors were established through the Generalized Estimation Equation (GEE) statistical method. The younger group’s average age is 28.02±1.40 and the elder group 36.57±1.7. There is no age-specific significant difference in terms of maternal confidence in the early postpartum period; however, maternal confidence shows an upward trend of increase following an increase in number of days postpartum although the change has not reached statistical difference. Social support is divided into three aspects including: “extent of need,” “assistance,” and “degree of adequacy.” In terms of “social support (extent of need),” there is no age-specific difference in the early postpartum period and there is little change following an increase in number of days postpartum. “Social support (assistance)” on the other hand shows age-specific differences in the early postpartum period. The elder primipara group received less “assistance” as compared to that of the elder primipara group; however, both groups sensed more “assistance” received following an increase in number of days postpartum although the difference in amount of assistance received has not reached significant difference. In terms of “social support (degree of adequacy)” there is age-specific difference in the early postpartum period, but the subjective perception of “degree of adequacy” between the two groups shows little change. After adjusting the effects of time and age groups, the GEE was adopted to analyze the correlation between maternal confidence and social support. The elder primiparas’ maternal confidence and social support in terms of “extent of need” show a negative correlation (-0.228 p=0.002) and the younger primiparas’ maternal confidence and social support in terms of “degree of assistance” also show a negative correlation (-0.168 p=0.049) . After adjusting the age and time variables, the influential factors of maternal confidence analyzed through the GEE include: Total family income and social support “extent of need”; the influential factors of social support “extent of need” include: education level and prenatal education courses; and the influential factor of social support “degree of adequacy” includes feeding method during the period of confinement care. Based on the research results, it is suggested that the maternal confidence and social support of postpartum women of different attributes be probed into in order to render appropriate care and enhance service quality for primiparas in the early postpartum period.