產科病房心理支持方案之可行性研究：以某醫學中心為例

The feasibility of an obstetric psychological support project at a medical center

女性在孕產期間的心理健康狀況應受到關注，而國內醫療機構在產婦生產過程中所實施的心理支持方案相當有限，並且未曾由受過心理學訓練之人員所執行，因此本研究以先驅研究的方式，探討心理學人員在產科實施心理支持方案之可行性。研究以質性典範進行，依據「聆聽式訪視」與「親嬰治療」之非指導式諮商、觀察、詮釋等方法，於中部某醫學中心產科病房執行共十週之「心理支持方案」，由五名心理系師生擔任會談者，共接觸68 名產婦。會談者於執行期間撰寫紀錄，並對紀錄內容進行分析。分析結果發現，在人時地狀況方面，產婦的生理狀況、會談者性別、住院生活步調、病室環境等對於心理支持方案之實施均有影響。在產婦與家屬的反應方面，產婦對方案的接受程度、投入狀況各異。產婦所關心的心理社會議題包括作息與坐月子方式、情緒、教養、夫妻與婆媳關係等；先生關心的是生活忙亂、教養；娘家在意的是產婦是否被妥善地照顧，婆婆則對產婦的坐月子方式有著複雜的情緒。依據研究結果，研究者建議未來的產科心理支持，在實務上可朝孕期宣導、設計會談主題、以家庭為中心、依據產科特性訓練心理學人員、加強醫護與心理人員之合作等方向著手。在研究上，則應發展孕產期心理衛生之評量工具，並對心理支持方案進行效果評估。

Perinatal mental health of women is an important issue that deserves attention. However， few psychological support projects have been adopted in obstetric units and few psychology professionals have been involved in such projects. The purpose of this study was to preliminarily explore the feasibility of an obstetric psychological support project led by psychology professionals. Based on a qualitative paradigm， a ten-week psychological support project was implemented at a medical center in Central Taiwan. Based on the principles of Listening Visit and parent-infant psychotherapy， strategies of nondirective counseling， observation， and interpretation were used in this project. Five psychology professionals (one professor， four undergraduates) and sixty-eight women participated in this project. Content analysis was conducted to analyze the psychology professionals’ process records. In the person， time， and space aspects， several factors thatinfluenced the implementation of the project emerged. Those factors included: women’s physical wellbeing， the gender of interviewers， the pace during hospital stay， and the room environment. According to reactions of the participants， obstetric women showed different degrees of acceptance and involvement. For women， the most frequently raised psychosocial issues were postpartum living style， the way of “doing-the-month.” emotions， child-rearing problems， and relationships with partner and mother-in-law. Chaotic states of life and child-rearing challenges were psychosocial issues that husbands were concerned with. As for the obstetric women’s family of origin， they were most concerned about whether their daughters were appropriately taken cared of. For the mothers-in-law， they have mixed feelings about the ways for which “doing-the-month” were carried out. Based on the results， we suggest an early implementation of educational programs of the psychological support project for pregnant women and their families. We also address the importance of the structured， family-based counseling approach， further training for psychology professionals， and theircollaboration with medical staffs. The development of measures to assess perinatal mental health and the outcome ofpsychological support project are needed.