唇顎裂新生兒母親之個人衝擊與養育態度：產前因子對早期適應趨勢之預測力

Maternal Sense of Personal Impact and Child Rearing Attitudes toward Cleft Lip and/or Palate Newborns: The Predictability of Two Risk Factors Existing before Delivery

唇顎裂是先天缺陷中常見的一種。唇顎裂新生兒之外貌是母親所期待的完美胎兒形象的幻滅，其於哺餵功能上之缺陷、及在初生第一年即需面對的一連串修補手術更為母親在孩子出生早期即需面臨的挑戰，這些挑戰又很可能會影響母親對孩子的養育態度，並進一步攸關孩子未來的社會情緒發展。本研究的主要目的，是探討影響唇顎裂兒母親早期養育態度的因子與其影響力之消長，並期望透過對母親早期適應過程的瞭解，而對唇顎裂新生兒之母親提供必要之輔導。本研究採縱貫追蹤，在唇顎裂兒出生後與第一次唇修補手術後，分兩次對五十名唇顎裂新生兒的母親施以問卷調查。測量變項包括兩個產前因子與兩個產後適應指標，分別為：以Epstein（1983）之Mother- Father-Peer Scale（MFP）作為測量母親本身的早期依戀關係的工具（包括「接納或拒絕」和「鼓勵獨立或過度保護」兩分量表）；母親在懷孕期間對孩子的功能性預期；孩子出生後為唇顎裂對母親個人的衝擊程度（初生早期及唇修補手術後各測一遍）；以及母親對孩子的養育態度（又分為「接納」與「過度保護」兩個分量表，並在初生早期及唇修補手術後各測一遍）。結果發現，唇顎裂兒母親覺知她的原生父母對她的拒絕與過度保護的程度，以及在懷孕期間對孩子的功能性預期，可預測孩子為唇顎裂對母親的衝擊程度；孩子為唇顎裂對母親的衝擊程度又可預測母親對孩子接納與鼓勵獨立的養育態度。母親在唇顎裂兒初生早期與唇修補手術後的衝擊程度及對孩子的接納度並沒有顯著差異；但母親對孩子的過度保護程度卻在術後顯著下降，而且也不再受兩個產前因子或手術前衝擊程度的影響，顯示第一次唇修補手術對母親養育態度所引發的質變與唇顎裂兒母親早期適應趨勢的變動與影響因子之消長。本研究建議，對於唇顎裂兒母親的輔導，應從她在懷孕前與生產前就已然存在的心理狀態與對自我家庭角色的期待著手。

Cleft lip and/or palate (CLP) is one of the most common congenital abnormalities in Taiwan. During pregnancy, expectant mothers often assume that the unborn child is perfect without any flaw or defect. Consequently, as a baby with obvious morphological defect is born, disappointment and feeling of personal failure seems inevitable. The disappointment may not only cause negative personal impact on the mother but also affect her child-rearing attitude toward the CLP infant, which, in turn, may have significant impact on the child's future socioemotional adjustment. The main goal of the present study is to investigate the vicissitude of the affecting factors toward maternal child rearing attitude during the first few months after delivery. The present study adopted a short-term longitudinal approach. Fifty cleft lip/palate newborns' mothers completed questionnaires both before and after the first lip repair surgery held between the third to the fifth month after delivery. Two prenatal factors, maternal perceived early relationship with her own parents that is further separated into two subscales of "acceptance vs. rejection" and "encouragement of independence vs. overprotection", and maternal functional anticipation of the unborn child while expecting, were measured. Two postpartum maternal adjustment indexes of sense of personal impact over giving birth to CLP infant and child rearing attitude, including subscales of "acceptance" and "overprotection", were also measured. Results indicate that the first repair surgery may trigger qualitative change in child rearing attitude and the variation of prenatal factors that are effective in enhancing maternal adjustment process. It is thus suggested that maternal psychological conditions already existed while or even before expecting should be taken into account in designing the intervention program for mothers of CLP and other types of morphologically defect newborns.