以敘事書寫反思被忽略的恥骨聯合分離問題

The Neglected Problem of Symphysis Pubis Diastasis through a Written Narrative

懷孕分泌大量黃體素及鬆弛素，是未懷孕婦女的10 倍，使婦女骨盆環可動性增加，屬於生理性且無症狀的關節鬆軟。陰道分娩若造成產後恥骨聯合分離（symphysis pubis diastasis, SPD）、受創，產生鬆弛、變形或移位時，恥骨之間有不正常的間距，導致急性骨盆疼痛，是少見卻常難以辨識的合併症。無論是懷孕或產後期間發生恥骨聯合分離疼痛的問題，因為發生率低，醫護人員對此辨識的經驗或認知不足，不了解其嚴重性，反而無法同理婦女經歷的痛苦。婦女不僅面臨嚴重疼痛無法行走，也會導致個人與人際關係受影響。本文以臨床照護經驗敘事書寫（narrative writing）為例，期望婦女一旦面臨恥骨聯合分離疼痛的問題時，能被關注與重視，早期發現、早期診斷與提供妥善處置，可減少及預防合併症發生，同時也提升婦女正向的生產經驗。

Pregnant women secrete large amounts of progesterone and relaxin – 10 times the level of women who are not pregnant. This increases the flexibility of the female pelvic girdle by a kind of physiological but asymptomatic loosening of the joints. If vaginal delivery causes postpartum symphysis pubis diastasis (SPD) and injury, leading to instability, deformation or displacement, an irregular gap can arise between the two pelvic bones, giving rise to acute pelvic pain. This is a rare and frequently unrecognized complication that is very difficult to identify. Regardless of whether SPD pain problems occur during pregnancy or postpartum, healthcare professionals demonstrate inadequate knowledge and experience or recognition of it. They do not grasp its severity and are unable to empathize with the woman’s distress caused by the pain. Women not only experience pain so severe that they are difficult to walk, but can also find their personal and interpersonal relationships adversely affected. This article is based on a written narrative of the experience of practical care. We hope to prompt a greater concern over and focus on the problem of SPD pain faced by women. Early recognition and diagnosis, and provision of appropriate medical treatment, can reduce or prevent incidence of complications. At the same time, it fosters in women a positive experience of giving birth.