台灣孕產照護制度中的醫療資訊落差與制度性困境：孕婦歷程觀點

Abstract

本研究採用自我民族誌方法，紀錄並分析研究者自2024年底確認懷孕起至孕期第34週的身心歷程與醫療互動。隨著懷孕週數推進，研究者透過實地參與與第一人稱書寫，細緻描繪自身在產檢流程、檢查選擇、自費項目決策與衛教理解等情境中的感受、思考與行動。研究旨在從個人經驗出發，探討台灣孕產照護制度中資訊傳遞與醫療決策支持的運作現況，進而揭示潛藏其中的資訊落差與制度性困境。 研究發現，儘管台灣健保制度提供14次常規產檢與部分檢查補助，但有關自費醫療項目的資訊取得與理解常需依賴孕婦主動查詢與診間即時詢問。孕婦健康手冊與現有衛教機制雖具參考價值，實際運作上在個別化溝通與即時回應方面仍有侷限。臨床診療時間有限，加上醫病互動模式多偏向單向傳遞，亦影響孕婦的理解與參與感。此外，研究也觀察到網路社群與數位工具在孕婦資訊補充、經驗交流與情緒支持中扮演日益關鍵的角色。 進一步地，本研究從制度設計、醫療文化與社會規訓等面向，探討孕婦於懷孕歷程中所經歷的決策壓力與心理調適。透過長期的田野觀察與跨週期的經驗整合，本文嘗試呈現個體經驗與結構因素之間的交織關係，提供對現行孕產照護政策、資訊設計與孕婦支持系統之反思與建議。自我民族誌作為一種深描個人經驗的質性研究方法，有助於揭示一般孕婦在制度運作下的實際感受與需求，補足量化資料中難以呈現的細節與情緒面向，進而促進以使用者經驗為核心的照護與政策改善。

This study adopts an autoethnographic approach to document and analyze the researcher’s physical and emotional experiences, as well as her interactions with the healthcare system, from the confirmation of pregnancy in late 2024 through the 34th week of gestation. As the pregnancy progresses, the researcher engages in immersive participation and first-person narrative writing to describe in detail her perceptions, reflections, and actions within various contexts, including prenatal check-up procedures, test selections, decisions about self-paid items, and the comprehension of health education. The study aims to investigate how information dissemination and medical decision-making support operate within Taiwan’s maternal healthcare system, and to uncover the underlying information gaps and structural challenges faced by pregnant women. Findings indicate that although Taiwan’s National Health Insurance (NHI) system provides 14 routine prenatal checkups and partial subsidies for selected tests, access to and understanding of information about self-paid medical services often depend on the pregnant woman’s own initiative and real-time inquiries during consultations. While the maternity handbook and existing health education mechanisms offer useful references, they remain limited in personalized communication and real-time responsiveness. Time constraints in clinical practice, combined with a largely one-way doctor–patient interaction model, also affect the pregnant woman’s sense of understanding and participation. In addition, the study observes that online communities and digital platforms are playing an increasingly important role in supplementing medical information, sharing experiences, and offering emotional support. Furthermore, this study examines the psychological adjustments and decision-making pressures experienced by pregnant women through the lenses of institutional design, medical culture, and social regulation. Through long-term field observation and the integration of experiences across pregnancy stages, the study seeks to illuminate the interplay between individual experience and structural factors. Autoethnography, as a qualitative method that captures personal narratives in depth, helps to articulate the real needs and feelings of pregnant women within the system—needs often overlooked in quantitative data. This approach contributes to more user-centered insights for improving maternity care policies, information design, and support mechanisms.