台灣重複剖腹產婦女的決策過程

The Decision-Making Processes in Taiwanese Women With Repeat Caesarean Deliveries

背景：重複剖腹產為台灣高剖腹產率的主因，超過90%的先前剖腹產台灣婦女，在下次懷孕後仍會選擇剖腹產。目的：探討台灣婦女選擇重複剖腹產的決策過程。方法　採質性研究的紮根理論方法，於北台灣醫學中心婦產科門診收案。資料收集包括：深度訪談、觀察及田野紀錄，資料分析採用紮根理論的持續比較分析法。結果　共訪談１６位選擇重複剖腹產婦女，研究發現，確保母胎健康是婦女選擇重複剖腹產決策的核心主題。婦女的決策受到內在因素（負向的生產經驗、考量子宮破裂風險、處理剖腹的疤痕組織及目前的懷孕狀況）和外在因素（產科醫生的建議、重要女性家人或友人的經驗、不正確的網路訊息及健保無條件給付重複剖腹產）影響。決策過程包括四個步驟為：搜尋生產方式訊息、評估陰道生產風險、信任產科醫生的專業判斷及無產程進展。結論／實務應用　關注母胎健康是婦女選擇重複剖腹產的主要原因。在內外因素的影響下，大多數台灣婦女被動地參與生產決策過程，以降低子宮破裂的風險。臨床應用上，醫院應減少不必要的催生介入，產科醫師亦應充分並客觀地告知婦女各種生產方式的風險與優勢，政府則應建構值得信賴的網路及嚴謹的重複剖腹產給付標準，以協助婦女做最佳的生產決策。

Background: Repeat caesarean delivery (RCD) ranks as the top reason for the high caesarean rates in Taiwan. More than 90% of Taiwanese women who have had a previous caesarean delivery chose RCD following their next pregnancy. Purpose: To explore the decision-making processes regarding RCD in Taiwanese women. Methods: A qualitative approach with grounded theory was used to conduct this research. Participants were recruited from a private medical centre in northern Taiwan. Methods of data collection include in-depth interviews, observation, and field notes. Constant comparative analytical techniques were employed for data analysis. Results: A total of 16 women chose RCD. Ensuring the well-being of mother and fetus was the core theme. Women’s decisions were influenced by both internal factors (previous negative experience of birth, concern about uterine rupture, fixing the scar of previous caesarean and current pregnancy situation) and external factors (obstetrician’s recommendation, the experience of female significant others, an inaccurate information from internet and the unconditional financial coverage from Health National Insurance). Decision-making processes involved searching information regarding mode of birth, evaluating vaginal birth risk, trusting obstetricians’ professional judgment, and a lack of progress during the course of labour. Conclusions / Implications for Practice: The well-being of mother and fetus is the major concern affecting mothers’ decisions regarding RCD. The majority of Taiwanese women participate passively in the decision-making process regarding their options for mode of birth. In the present study, women choices were primarily guided by reducing the risk of uterine rupture. Hospitals should reduce unnecessary induction interventions. Obstetricians should inform women of the risks and benefits of various birth modes. The government could establish a website that provides a clear explanation of the criteria for the government to financially cover the costs of RCD in order to assist women to make optimal birth choices.