入院待產時機教育課程於孕婦焦慮、不確定感、生產控制感及待產結果之成效

Effectiveness of a Labor-Admission Education Program on Anxiety, Uncertainty, Locus of Labor Control, and Labor Outcomes in Pregnant Women

10.6224/JN.201904_66(2).06

梁慧敏(Hui-Min LIANG)；高美玲(Meei-Ling GAU)；陳治平(Chie-Pein CHEN)；劉介宇(Chieh-Yu LIU)

入院待產時機教育課程 ； 焦慮感 ； 不確定感 ； 生產控制感 ； 待產結果 ； timing of admission in labor of educational program ； anxiety ； uncertainty ； labor-related locus of control ； labor outcomes

護理雜誌

66卷2期（2019 / 04 / 01）

36 - 47

繁體中文

背景：過早入院到陌生醫療場景待產易使孕婦產生焦慮、不確定及失控感，教育孕婦等待適當入院時機，能減少往返產房與家中的辛苦，降低非必要醫療措施。目的：探討入院待產時機教育課程於孕婦焦慮、不確定感、生產控制感及待產結果之成效。方法：採類實驗設計，共收151位低危險群之單胞胎初孕婦，實驗組76位於妊娠35週以上的產檢日接受入院待產時機教育課程，課程次數為一次，共計一小時，課程內容分為三單元：「正常產兆與待產時機」、「產兆來臨之居家備忘錄」、「危險徵兆的認識」；控制組75位未接受。於介入方案前及產後3天內填寫結構式問卷：基本人口產科學資料、焦慮感與不確定感視覺類比量表、生產控制感量表以及待產結果資料。結果：入院待產時機教育課程能降低孕婦焦慮及不確定感（p ＜ .001）、提高生產控制感（p = .001），掌握較正確入院時機（p = .001）、減少被拒絕入院返往家中的次數（p = .007）及諮詢次數（p ＜ .001），提高子宮頸擴張達3公分後入院的比率（p ＜ .001）以及降低催生機會（p = .002）。結論／實務應用：藉由入院待產時機教育課程，鼓勵孕婦無危險徵兆時，延長第一產程潛伏期居家時間，以降低焦慮、不確定感，提高生產控制感及較佳待產結果。

Background: The process of hospital admission undergone by expectant mothers readily induces feelings of loss of control, anxiousness, and uncertainty. Thus, education to promote the proper response of women to their impending hospital admission may be beneficial in terms of minimizing the number of labor-related hospital trips and the wastage of medical resources. Purpose: To explore the effects a labor-admission education program on perceived anxiousness, uncertainty, locus of control, and labor outcomes in expectant mothers. Methods: A quasi-experimental research design was used to recruit participants. Eligible participants were primipara women who were expected to experience a complications-free pregnancy with a single fetus. A total of 151 participants were enrolled, with 76 assigned to the experimental group and 75 assigned to the control group. The experimental group received the labor and delivery education program intervention while the control group received standard nursing guidance. Participants received the education program in their regular prenatal checkup after the 35th gestational week. The intervention (education program) lasted an hour and included three parts: normal labor signs and appropriate timing of labor admission, self-care strategies at home, and indicators of the onset of labor. A structured questionnaire, including a basic OB/GYN datasheet, the Visual Analogue Scale (VAS) of uncertainty and anxiety, the Labor Agentry Scale (LAS), and birth-outcome information, was used to collect data. Participants completed the three scales at two time points: 1) prior to admission and after the education program and 2) at 3-days postpartum. Results: The findings support the effectiveness of providing a pre-admission education program in terms of lowering perceived uncertainty and anxiousness (p ＜ .001), enhancing the locus of control during birth (p = .001), increasing awareness of the proper time for admission after the onset of labor (p = .001), and reducing the numbers of repeat trips to the hospital (p = .007) and consultations (p ＜ .001). Further, the education program may improve the rate of 3cm-or-greater cervical dilation at admission (p ＜ .001) and reduce the need for induced deliveries (p = .002). Conclusions/Implications for Practice: In the absence of contraindications, this education program should be provided to expectant mothers as an effective method to maximize the duration of the at-home, latent phase of labor in order to increase locus of control over delivery, reduce uncertainty and anxiousness, and attain optimal birth outcomes.

1. Lai, M. L.,Lin, K. C.,Li, H. Y.,Shey, K. S.,Gau, M. L.(2009).Effects of delayed pushing during the second stage of labor on postpartum fatigue and birth outcomes in nulliparous women.The Journal of Nursing Research,17(1),62-72.
   連結：
2. Lin, Y. C.,Gau, M. L.,Kao, G. H.,Lee, H. C.(2018).Efficacy of an ergonomic ankle support aid for squatting position in improving pushing skills and birth outcomes during the second stage of labor: A randomized controlled trial.The Journal of Nursing Research,26(6),376-384.
   連結：
3. 郭素珍, S. C.(2015)。從性別觀點看醫療化的婦女生產。護理雜誌，62(1)，10-15。
   連結：
4. Bohra, U.,Donnelly, J.,O’Connell, M. P,Geary, M. P.,MacQuillan, K.,Keane, D. P.(2003).Active management of labour revisited: The first 1000 primiparous labours in 2000.Journal of Obstetrics and Gynaecology,23(2),118-120.
5. Carlsson, I.-M.,Ziegert, K.,Sahlberg-Blom, E.,Nissen, E.(2012).Maintaining power: Women's experiences from labour onset before admittance to maternity ward.Midwifery,28(1),86-92.
6. Caughey, A. B.,Cahill, A. G.,Guise, J.-M.,Rouse, D. J.(2014).Safe prevention of the primary cesarean delivery.American Journal of Obstetrics and Gynecology,210(3),179-193.
7. Chuma, C.,Kihunrwa, A.,Matovelo, D.,Mahendeka, M.(2014).Labour management and obstetric outcomes among pregnant women admitted in latent phase compared to active phase of labour at Bugando Medical Centre in Tanzania.BMC Pregnancy and Childbirth,14,68.
8. Cohen, J.(1988).Statistical power analysis for the behavioral sciences.Hillsdale, NJ:Lawrence Erlbaum Associates.
9. Durand, A. M.(1992).The safety of home birth: The farm study.American Journal of Public Health,82(3),450-453.
10. Eri, T. S.,Blystad, A.,Gjengedal, E.,Blaaka, G.(2010).Negotiating credibility: First-time mothers’ experiences of contact with the labour ward before hospitalisation.Midwifery,26(6),e25-e30.
11. Escott, D.,Slade, P.,Spiby, H.,Fraser, R. B.(2005).Preliminary evaluation of a coping strategy enhancement method of preparation for labour.Midwifery,21(3),278-291.
12. Faul, F.,Erdfelder, E.,Buchner, A.,Lang, A.-G.(2009).Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses.Behavior Research Methods,41(4),1149-1160.
13. Ferguson, S.,Davis, D.,Browne, J.(2013).Does antenatal education affect labour and birth? A structured review of the literature.Women and Birth,26(1),e5-e8.
14. Firouzbakht, M.,Nikpour, M.,Khefri, S.,Jamali, B.,Kazeminavaee, F.,Didehdar, M.(2015).The effectiveness of prenatal intervention on pain and anxiety during the process of childbirth-Northern Iran: Clinical trial study.Annals of Medical & Health Sciences Research,5(5),348-352.
15. Gau, M. L.,Chang, C. Y.,Tian, S. H.,Lin, K. C.(2011).Effects of birth ball exercise on pain and self-efficacy during childbirth: A randomised controlled trial in Taiwan.Midwifery,27(6),e293-e300.
16. Geerts, C. C.,Klomp, T.,Lagro-Janssen, A. L.,Twisk, J. W.,van Dillen, J.,de Jonge, A.(2014).Birth setting, transfer and maternal sense of control: Results from the DELIVER study.BMC Pregnancy and Childbirth,14,27.
17. Gift, A. G.(1989).Visual analogue scales: Measurement of subjective phenomena.Nursing Research,38(5),286s-288s.
18. Goodman, P.,Mackey, M. C.,Tavakoli, A. S.(2004).Factors related to childbirth satisfaction.Journal of Advanced Nursing,46(2),212-219.
19. Hodnett, E. D.(1989).Personal control and the birth environment: Comparisons between home and hospital settings.Journal of Environmental Psychology,9(3),207-216.
20. International Childbirth Education Association(2011).The ICEA guide to pregnancy & birth.Raleigh, NC:Author.
21. Ip, W.-Y.,Tang, C. S.,Goggins, W. B.(2009).An educational intervention to improve women's ability to cope with childbirth.Journal of Clinical Nursing,18(15),2125-2135.
22. Janna, J. R.,Chowdhury, S. B.(2013).Impact of timing of admission in labour on subsequent outcome.Community Based Medical Journal,2(1),21-28.
23. Kauffman, E.,Souter, V. L.,Katon, J. G.,Sitcov, K.(2016).Cervical dilation on admission in term spontaneous labor and maternal and newborn outcomes.Obstetrics and Gynecology,127(3),481-488.
24. Larkin, P.,Begley, C. M.,Devane, D.(2012).‘Not enough people to look after you’: An exploration of women's experiences of childbirth in the Republic of Ireland.Midwifery,28(1),98-105.
25. Lee, S. L.,Liu, C. Y.,Lu, Y. Y.,Gau, M. L.(2013).Efficacy of warm showers on labor pain and birth experience during the first labor stage.Journal of Obstetric, Gynecologic, & Neonatal Nursing,42(1),19-28.
26. Lothian, J.,DeVries, C.(2012).The official Lamaze guide: Giving birth with confidence.New York, NY:Simon and Schuster.
27. Lumluk, T.,Kovavisarach, E.(2011).Effect of antenatal education for better self-correct diagnosis of true labor: A randomized control study.Journal of the Medical Association of Thailand,94(7),772-774.
28. McNiven, P. S.,Williams, J. I.,Hodnett, E.,Kaufman, K.,Hannah, M. E.(1998).An early labor assessment program: A randomized, controlled trial.Birth,25(1),5-10.
29. Miquelutti, M. A.,Cecatti, J. G.,Makuch, M. Y.(2013).Antenatal education and the birthing experience of Brazilian women: A qualitative study.BMC Pregnancy and Childbirth,13,171.
30. National Institute for Health and Care Excellence. (2017). Intrapartum care for healthy women and babies. Retrieved from http://www.nice.org.uk/guidance/cg190
31. Nyman, V.,Downe, S.,Berg, M.(2011).Waiting for permission to enter the labour ward world: First time parents’ experiences of the first encounter on a labour ward.Sexual and Reproductive Healthcare,2(3),129-134.
32. Oladapo, O. T.,Diaz, V.,Bonet, M.,Abalos, E.,Thwin, S. S.,Souza, H.,Gülmezoglu, A. M.(2018).Cervical dilatation patterns of "low-risk" women with spontaneous labour and normal perinatal outcomes: A systematic review.BJOG: An International Journal of Obstetrics and Gynaecology,125(8),944-954.
33. 方惠珍, H. C.,劉介宇, C. Y.,戴蕙蓮, H. L.,陳治平, C. P.,高美玲, M. L.(2011)。健康諮詢介入措施對非住院高危險妊娠孕婦不確定感、壓力與生產結果之成效。護理暨健康照護研究，7(1)，3-13。
34. 王秀梅, S. M.,陳惠敏, H. M.,徐秋玉, C. Y.,張慧先, H. H.(2007)。音樂治療對於子宮全切除婦女焦慮程度改善之影響。長庚護理，18(1)，11-20。
35. 翁敏雪, M. H.,李從業, T. Y.,李文宗, W. C.(2003)。產前錄影帶衛教介入措施對產婦分娩自我控制成效之探討。新臺北護理期刊，5(2)，49-58。
36. 高美玲, M. L.,高千惠, C. H.(2013)。苦不堪言的生產疼痛？迷思與護理照護。護理雜誌，60(6)，11-15。
37. 國民健康署（2015）．孕婦產前健康照護衛教指導服務．取自http://www.hpa.gov.tw/Pages/List.aspx?nodeid=195 [Health Promotion Administration, Taiwan, ROC. (2015). Prenatal health education and guidance. Retrieved from http://www.hpa.gov.tw/Pages/List.aspx?nodeid=195]
38. 國民健康署, Taiwan, ROC.(2017).孕婦健康手冊.台北市=Taipei City, Taiwan, ROC:作者=Author.
39. 黃麗華, L. H.(2011)。臺北市，國立臺北護理健康大學護理助產研究所=National Taipei University of Nursing and Health Sciences。
40. 黃鶯滿, Y. M.,鍾聿琳, U. L.,郭素珍, S. C.,祝春紅, C. H.(2007)。產婦對生產教育內容需求的探討。助產雜誌，49，21-27。
41. 盧玉嬴, Y. Y.,劉書玉, S. Y.,高美玲, M. L.,吳淑芳, S. F.,梁淑媛, S. Y.(2013)。東台灣地區婦女生產經驗及其相關因素探討。護理暨健康照護研究，9(4)，301-310。