孤帆遠航: 台灣女性因應胎兒異常疾病終止妊娠之生命經歷詮釋

Abstract

因著台灣的優生學脈絡，近年來自費產檢項目廣受孕產家庭青睞，然而也帶 來妊娠過程中得知的胎兒有異常疾病。孕產家庭因而經歷告知與診斷、醫療說 明、抉擇、產後照顧等四個階段，產後的自我照顧正是研究者所感興趣的階段， 因終止妊娠意味著與寶寶道別，女性該如何處理哀傷?這個過程中可能面臨什麼 樣的挑戰?而這群女性又是如何看待這段經歷呢?因故本研究目的為以下四 點:(一)探究因胎兒異常終止妊娠女性的生命經歷、(二)探究女性因應胎兒異 常的終止妊娠事件的支持系統、(三)探究女性賦予終止妊娠事件的生命意義、 (四)探究因胎兒異常終止妊娠女性，對於現行健康照護體制服務的看法。 本研究以質性研究為研究取向，透過敘事研究方法，從受訪者的生命經驗出 發，透過敘說找到生命事件的影響與意義。以立意抽樣及滾雪球抽樣尋找 6 位受 訪者，均為懷孕第二孕期(懷孕第 17 週至第 29 週)，經相關檢查發現胎兒有異 常疾病，且妊娠決策為終止妊娠者。本研究發現受訪者終止妊娠後會經歷一連串 的心理健康風暴，包括難以平復的情緒、難過、低潮，甚至是嫉妒與罪惡感，受 訪者在復元歷程中的支持大多來自配偶、家庭、職場、醫療團隊，而這些支持網 絡有著正向與負向的效果，能讓女性抒發、講述有療癒的正向效果，拒絕談論及 給予不適切回應的系統則帶給女性更大的痛苦或悲傷處理的空白，女性終究將採 取行動開始自我療癒與踏上復元之路，從自身內在的療癒開始，逐漸向近端的生 活環境出發，到遠端的文化、宗教儀式處理及行善社會與成為助人者。 本研究建議有以下五點:(一)急性醫療場域應建置終止妊娠之關懷服務團 隊、(二)醫療團隊應提供終止妊娠相關之明確資訊、(三)經歷終止妊娠應被視 為一種心理健康危機，有評估及轉介機制、(四)相關支持女性的服務應以家庭 為中心的理念提供，以及(五)台灣社會應將文化脈絡納入健康照護體系。經歷因懷有胎兒異常疾病的女性，往後的人生因著終止妊娠而轉了一個大彎，然而當 前台灣的研究仍對此議題顯少著墨，本研究透過受訪者的生命經歷與觀點，描繪 女性所經歷的困境，以及出走困境之法，希望藉此提供實務工作相關指引，使相 似經歷的女性都能在醫療場域、健康照護系統中得到合適的協助與照護。

Due to the context of eugenics in Taiwan, self-pay prenatal examination has become increasingly popular among pregnant families in recent years. However, this also brings with the discovery of fetal abnormalities during pregnancy. Pregnant families confront four stages during the medical process: disclosure and diagnosis, medical explanation, decision-making, and postpartum care. This study focuses on the postpartum self-care stage, as termination of pregnancy signifies a farewell to the baby. How could women cope during this process? What challenges might they encounter? How do these women perceive their experiences? Therefore, there are four research purposes: (a) explore the life experience of women who terminate pregnancy due to fetal abnormalities, (b) investigate the supposed system available to women coping with pregnancy termination due to fetal abnormalities., (c) examine how women define the meaning of their life experiences, (d) investigate women's perspectives on the healthcare system. This qualitative research utilizes the narrative approach to explore the participants’ life experiences. The study explores the impact and significance of these life events through storytelling. The research used purposive and snowball sampling methods to select six participants, all of whom were in the second trimester of pregnancy (weeks 17 to 29) and had terminated their pregnancies after prenatal examination identified fetal abnormalities. The findings indicate that women who terminated their pregnancies experienced a series of emotional and psychological challenges, including grief, sadness, depression, and even feelings of jealousy and guilt. The support women received during their resilient process primarily came from spouses, families, workplaces, and clinical care teams. These support networks had both positive and negative effects, positive support helped facilitate emotional expression and healing, while negative responses, such as refusing to talk about the event or offering inappropriate reactions, intensified emotional distress and left a void in emotional processing. Despite these challenges, most women eventually initiated self-healing processes, beginning with inner healing, extending to their life environment, and even reaching more distant cultural and religious practices, including acts of charity and becoming helpers for others. This study explores five recommendations: (1) clinical care system should establish multidisciplinary care for pregnancy termination; (2) clinical care system should provide specific information regarding pregnancy termination; (3) pregnancy termination should be regarded as a psychological health crisis, with assessment and referral; (4) services supporting women should adopt a family-centered care model; and (5) the healthcare system in Taiwan should incorporate cultural contexts into its framework for healthcare system. In conclusion, for women who terminate their pregnancies due to fetal abnormalities, the event represents a significant turning point in their lives. However, current research in Taiwan on this issue is still limited. Through the life experiences and perspectives of the participants, this study aims to depict the dilemmas these women face and the strategies they use to overcome them. The findings are intended to provide practical guidance for professionals, ensuring that women with similar experiences receive appropriate support and care within clinical and healthcare systems.