不同孕次婦女之孕期心理社會適應的比較

A Comparison of Maternal Psychosocial Adaptation among Pregnant Women with Different Gravidity

本研究目的旨在探討婦女處於不同孕期的心理社會適應情形並針對不同孕次（初、經孕婦）的婦女進行孕期適應的比較分析；屬描述性、比較性之橫斷式研究設計，共收案717名南部醫院的懷孕婦女（初孕婦369人、經孕婦348人）。研究工具包括人口學基本資料和中文版孕期適應自我評量表。結果發現：（1）不同孕次婦女在三個孕期的適應中，經孕婦之「與配偶關係」分量表有顯著的差異，經孕婦於第三孕期較第一孕期在「與配偶關係」的適應上顯著較差。（2）以共變數分析計算調整年齡層、婚姻及計畫懷孕後之調整後平均值，進行比較分析，結果發現，不同孕次婦女在孕期適應總量表與「自我與寶寶的安寧」、「準備生產」及「害怕產中的無助與失控」等分量表皆有顯著性差異，顯示初孕婦的孕期適應較經孕婦差，且較擔心自我與寶寶安寧、準備生產和害怕產中的無助與失控。本研究結果可提供醫護人員產前照護的參考依據；護理人員可於孕婦常規產檢時檢測其心理社會適應狀況，適時加強初孕婦對生產的了解及提升其生產自我控制的能力，並進一步了解經孕婦於第三孕期與其配偶的關係且提供適時的協助，讓孕婦們有個較愉快的懷孕生產經驗。

The purpose of this study was to examine women's psychosocial adaptation during different trimesters of pregnancy and to compare maternal psychosocial adaptation between primigravida and multigravida. A cross-sectional and comparative research design was conducted. A convenience sample consisting of 717 pregnant women who made a prenatal clinical visit in southern Taiwan were recruited for this study. The sample included 369 primigravida and 348 multigravida. A Demographic Inventory and the Chinese version of the Prenatal Self-Evaluation Questionnaire (PSEQ) were used to collect data. Results found that (1) the subscale ”relationship with husband” for multigravida showed statistically significant differences between the three trimesters, with scores for the third trimester higher than those for the first. Also, multigravida had poorer adaptation on ”relationship with husband” in the third trimester than in the first; (2) Analysis of covariance was used to adjust for age, marital status and planned pregnancy, as the distribution of such variables was significantly different between primigravida and multigravida. Results showed significant differences between the two sample groups in terms of PSEQ total scores and scores for ”concern for well-being of self and baby,” ”preparation for labor,” and ”fear of helplessness, and loss of control in labor.” This indicates that primigravida had poorer maternal psychosocial adaptation than multigravida and worried more about ”concern for wellbeing of self and baby,” ”preparation for labor,” and ”fear of helplessness, and loss of control in labor.” The findings of this study provide evidence-based data to help nursing professionals provide more suitable nursing care to pregnant women. Nurses should assess pregnant women’s psychosocial adaptation during their prenatal visiting and then assist them to better understand the process of childbirth and enhance their level of control during labor. In addition, nurses should appraise women's relationships with their husbands during the third trimester and supply appropriate nursing care to pregnant women for a more pleasant pregnancy and labor experience.