協助一位懷雙胞胎剖腹產婦女增進親子連結之護理經驗

Nursing Experience of A Twin with Caesarean Section Woman in Enhancing Mother-Infant Bonding

本文旨在描述一位剖腹產生下低體重雙胞胎之婦女，所造成的生理及心理困擾之護理經驗。護理期間自2018年10月08日至2018年11月20日。照護期間運用Gordon十一項健康功能型態為評估架構，確立個案有：「急性疼痛」、「身體心像改變」及「母職角色功能缺失」之健康問題。在照護期間，提供對疼痛轉移注意力的方法、避免傷口受到牽扯的方法及促進傷口癒合的方法，以緩解疼痛，個案疼痛指數由4分降至1分以下；對於個案負向之身體心像不予以批判，並鼓勵說出心中的感受，根據個案所關注的問題提供相關訊息，如產後身材改變的原因、增進子宮收縮的方法、增強腹部肌肉張力的方法及飲食控制的原則，在出院前個案能執行擠奶動作及產後運動，出院前的體重也回復到接近孕前的體重；鼓勵個案表達面對雙胞胎的感受，協助個案了解嬰兒之身體狀況，以減少個案對嬰兒的不安，筆者進而提供個案增進親子連結之相關措施，如說明親子互動的好處、示範採漸進式接觸嬰兒、說明與嬰兒互動方法、判別嬰兒哭鬧原因及照顧嬰兒基本技巧，之後個案能夠主動與嬰兒互動、擁抱嬰兒、熟悉照顧技巧及增加親子同室的時間。建議針對新手母親，需要細心觀察及支持，以協助其順利的過渡至放手期，學習成為一個母親。盼藉此經驗能提供護理人員作為日後在照顧類似個案之參考。

This case report describes the nursing experience of physical and psychological distress caused by a woman who gave birth to a low-weight twin under caesarean section. The nursing period was from October 08, 2018 to November 20, 2018, according to the data analyzed by the assessment tool of Gordon's 11 functional health patterns, the result indicated that the patient's nursing problem including acute pain, body image change and dysfunctional mother role. During the period of caring, the author provided the patient's pain relief methods, such as distracting attention from pain, avoiding wound being pulled, and promoting wound healing. Patient's pain score dropped from 4 points to less than 1 point. The author didn't criticize the negative body image of patient and encouraging the patient to speak feelings, then providing relevant information based on the concerns of the patient, such as the causes of postpartum body changes, methods for improving uterine contractions, methods for enhancing abdominal muscle tone, and principle of diet control. Before the discharge, the patient can express breast milk by hand and perform postpartum exercise, and the weight also returns to the weight before pregnancy. The author encouraged the patient to express the feelings of the twin, assisting the patient understand the baby's physical condition to reduce the uneasiness of the patient to the baby, then providing measures for the patient to enhance mother-infant bonding, such as explaining the benefits of parent-child interaction, demonstration adopts progressive contact with the baby, explaining how to interact with baby, discriminating the reason for the baby's crying, and taking care for baby's basic skills, and then the patient can actively interact with the baby, embrace the baby, familiar with baby care skills and increase the time rooming-in. It is recommended that the novice mother needs careful observation and support to help her smooth transition to a letting go phase and learning to be a mother. The findings are helpful to serve a reference to other nurses care of similar woman.