國內產婦使用無痛分娩之初探

Preliminary Survey of Painless Labor in a Medical Center

當先進國家婦女無痛分娩率已高達8成，我國採用無痛分娩比例仍停留在3-15%間，因此，嘗試從產婦層面瞭解產婦選擇生產方式的原因。於民國88年在北部某醫學中心收集產婦原擬及實際生產方式、決定原因及參考哪些人之意見、及產後併發症、新生兒健康情形及滿意度等。除描述性統計外，採用麥氏檢定比較產婦原擬及實際生產方式有沒有差異。共得有效問卷105份。原擬使用生產方式比例分別為自然產54.3%、無痛分娩16.2%、剖腹產29.5%；但實際使用生產方式比例卻是自然產42.9%、無痛分娩4.8%、剖腹產52.4%（p=.001），剖腹產率的提升主要是部份原擬使用自然產或無痛分娩產婦改用剖腹產。至於改變原因為產婦或胎兒的醫療需要、產婦無法忍受生產疼痛、或來不及使用無痛分娩。小部份產婦回答不知道無痛分娩的訊息。參考意見方面，原擬使用生產方式是以自己或丈夫意見為主，但如為醫療需要或改變生產方式多採醫師意見，暗示醫師在產婦實際使用生產方式扮演著非常重要角色。沒有死胎或畸胎出現。剖腹產組有較多人出現產後併發症，但三組產婦的整體滿意度相近。反映剖腹生產的併發症似乎沒有被強調，生產時忍受疼痛的感受在產後便沒有被聽聞。國內採用無痛分娩比例仍非常低，資訊不足、醫師不鼓勵是無痛分娩不普及的部份原因。建議醫護人員應主動提供產婦不同生產方法、適用情形、優缺點等訊息，產婦亦應主動找尋相關知識，選擇符合自己需要的方式生產。

The use of painless labor in our country is as low 3-15%, whereas it is 80% in developed countries. Data based on a questionnaire survey was collected from women who gave birth to explore how the decision of delivery was made and whom she was consulted with. A total of 105 valid samples were obtained from a medical center of northern Taiwan in 1999. Other than descriptive statistics, MeNemar's Chi-square was used to compare the proportion of proposed and actual delivery methods. The propotions of proposed delivery methods were: natural birth (54.3%), painless labor (16.2%), and cesarean section (29.5%). On the other hand, the proportions of actural delivery method were natural birth (42.9%). Painless labor (4.8%), and cesarean section (52.4%), which was significantly different from those of the proposed delivery methods (P =.001). Since some women, who originally intended to use natural-delivery or painless labor, changed to cesarean section. As a result, the actual cesarean section rate was much higher than the proposed one. A small number of women never heard of painless labor as another means of delivery. Physician's opinion was mainly referred when there were medical problems in the delivery women of in the fetus, or when the means of delivery was changed. This implied that physicians play a very important role in deciding the actual delivery method. Complication rate after birth were highest in those women who actually used cesarean to deliver babies, but the satisfaction score among the three delivery groups was not statistically significant. It implied that high complication rate of cesarean section was not emphasized and the pain suffered during childbirth would not be heard after the baby was born. The rate of painless labor is still very low in Taiwan. Lack of relevant information and discouragement from physicians were partly responsible for the low rate of painless labor. We suggest that the pros and cons of different delivery methods should be provided of pregnant women should search relevant information when making their decision of delivery.