孕產照護邏輯：台灣女性的新生育選擇與共同修補

The Logic of Maternity Care: Taiwanese Women's New Reproductive Choice and Shared Doctoring in Childbirth

1960年代後從美國開啟的兩波女性生育自主運動，強調對自我身體控制和生育選擇權。面對當代生產醫療過度介入問題，新興的生育改革運動延續選擇權訴求，將助產照護視為解決生產醫療化問題並回復自然的身體自主與生育選擇。相關研究指出當代女性生育選擇有限，助產照護作為生產的新選擇，是否可以促進女性生育自主與照護品質，又如何做到？為回答這些問題，本文分析近年台灣衛生福利部以試辦計畫引進助產師到醫療院所提供給女性的新選擇，討論共同照護模式下的女性經驗，藉此探討生育選擇與孕產照護實作。延伸Annemarie Mol的「照護邏輯」和「選擇邏輯」討論，本文探討台灣孕產照護實作，透過訪談和在北部一家醫院的參與式觀察，分析生產照護活動與待產本身的不穩定性和複雜性，以及選擇助產師或溫柔生產帶來的調節與修補。本文指出選擇有助於女性生育自主，但並非強調「選擇邏輯」。透過分析實作上的「照護邏輯」，可幫助我們了解在多變的產程和照護活動中，產婦需求、實證醫學、醫學常規之間如何因應當下狀況進行「共同修補」，以達成順利生產目的。 Since the 1960s, reproductive choice has been at the center of two waves of U.S.-led women's reproductive rights movements. In response to medicalization of childbirth, the women's movements asked for getting back to nature and for greater autonomy and free choice in method of birth. Many studies have shown that women's reproductive choices are limited by the social and medical system. Therefore, it is significant to examine what is the meaning of having reproductive choices within the medical practice, and how and to what degree the practice of midwifery and the idea of free choice empowers women's autonomy. Can choice bring better maternity care to women? To answer these questions, this paper explores Taiwanese women's new reproductive choices and their practice in maternity care. Based on interviews and participant observation in a local hospital which practices midwifery, the paper delineates women's new choices and how such choice influences women's experiences of maternity care. Drawing on Annemarie Mol's discussions on the logic of care and the logic of choice, this paper analyses women's situation in relation to choice, the constitution of choice, and how women's choice fluctuates during the process of birth. It first argues that having the opportunity to choose midwife care can facilitate women's agency and strengthen their autonomy because a midwife plays a role as an articulator in between women's needs and medical-led routine practice. However, this paper does not stress the importance of “the logic of choice”. Instead, it argues that, with successfully giving birth to a child as the goal, the improvements will depend on an adaptable shared doctoring mediating the pregnant women's needs and the medical-led routine practice, since the process of childbirth is unpredictable.