A Reinterpretation of Maternal Requests for Cesarean Sections in Taiwan

台灣“選擇性剖腹產”之重新解讀分析

10.6152/jaa.2010.06.0004

官晨怡(Chen-I Kuan)

剖腹產 ； 台灣 ； 性別政治 ； 人為風險 ； 反身性回應 ； Cesarean sections ； Taiwan ； gender politics ； manufactured risk ； reflexive response

考古人類學刊

72期（2010 / 06 / 01）

97 - 136

英文

本文檢視台灣剖腹產現象背後的性別政治。台灣剖腹產率高居世界第三，公共論述傾向將高剖腹產率歸罪於婦女的選擇。根據我的民族誌研究，醫院生產制度乃是造成高剖腹產率的主要因素。台灣醫院對於生產的高度醫療介入，在社會、心理與生理等面向上，皆增加了剖腹產的可能性。面對如此高剖腹產率，“痛兩次”（陰道產失敗後，接受剖腹產）成為台灣孕婦普遍的擔憂，部分婦女因而直接選擇剖腹產。本文將藉由分析台灣醫院生產系統，重新詮釋所謂的“選擇性剖腹產”。

This paper examines the gender politics of Cesarean sections (C-sections) in Taiwan, the country with the third highest Cesarean rates (C-rates) in the world. Public discourses attribute the high C-rates to the demands of women. According to my fieldwork, the Taiwanese medical system itself is responsible for high C-rates. Taiwanese hospitals enforce a significant amount of medical interventions that increases C-sections through social, psychological, and biological processes. Aware of these intervention practices, women request a C-section out of fear of ”suffering twice”, or in other words, trying to deliver vaginally but ending up having to have a C-section. I will re-interpret maternal requests of C-sections within this context.

1. Chatfield, Joanne 2001 ACOG Issues Guidelines on Fetal Macrosomia - American College of Obstetrics and Gynecologists: American Academy of Family Physicians..
2. Obstetrics in Guang-tian Hospital (光田綜合醫院婦產科醫師群)2008 Pofuchan dui baobao de houyizheng (剖腹產對寶的後遺症) [Negative Impact of Cesarean Section on Babies]. Uho Health Web (優活健康網),http://www.uho.com.tw/sex.asp?aid=4865, accessed January 10, 2009.
3. Wu, Jein-de (吳建德) 2004 Renshih pofuchan ji chi shuhou yinshi zhuyi shixiang (〈認識剖腹產及其術後飲食注意事項〉). [Understanding Cesarean Birth]. Taichung Dali Jenai Hospital (台中大里仁愛醫院網頁)http://www.jah.org.tw/chinese/5_knowledge/2_info/c/c01/06.asp, accessed December 15, 2008
4. Hsueh, Kui-wen (薛桂文) 2006 Liyou ziranchan bucheng jianbao diaogeifu zixingyaoqiu pofuchan duo fu 12000-18000 yuan. (〈利誘自然產不成 健保調給付 自行要求部腹產多付12000-18000元〉) [Unable to Increase Vaginal Births from the Doctor's Side; NHI Requires Extra Out-of-Pocket Payment of $12000-18000 for an Elective Cesarean Section.]. Minshengbao (民生報), April 22.
5. Lee, Suzen 2007 93% Episotomy Rates. PChome News, 10/03.
6. ET News (東森新聞) 2006 Yunfu yaociou popouchan, wuyueyirih ci syu zihfu liawanyuan (〈孕婦要求剖腹產五月一日起需自付兩萬元〉)[Pregnant Women Who Want Cesarean Sections have to Pay 20000 More Taiwanese Dollars After May First].http://tw.news.yahoo.com/060425/195/32hmz.html, accessed April 25.
7. Wang, Guo-gong (王國恭) 2005 Pofuchan. (〈剖腹產〉) [Cesarean Section]. National Taiwan University Hospital Website (臺大醫院網站), http://ntuh.mc.ntu.edu.tw/obgy/CD/spe/Spe_o08.html, accessed May 3, 2006
8. Department of Health of Executive Yuan, R. O. C .2005 Statistics of Hospital Service in 2005: Department of Health of Executive Yuan, R.O. C .
9. ACOG(2006).Patient-Requested Cesarean Update.ACOG News Release.
10. Anderson, Geoffery M(2004).Making Sense of Rising Caesarean Section Rates.British Medical Journal,329,697-698.
11. Beck, Ulrich(1992).Risk Society: Towards a New Modernity.Newbury Park, CA:Sage Publications.
12. Beck, Ulrich(2000).Risk Society Revisited: Theory, Politics and Research Programmes.The Risk Society and Beyond,London:
13. Beckett, Katherine(2005).Choosing Cesarean: Feminism and the Politics of Childbirth in the United States.Feminist Theory,6(3),251-275.
14. Cassell, Philip(ed.)(2003).The Giddens Reader.London:The MacMillan Press.
15. Chou, Yiing-jenq(2006).Do Physicians and Their Relatives Have a Decreased Rate of Cesarean Section? A 4-Year Population-Based Study in Taiwan.Birth,33(3),195-201.
16. Clarke, Adele E.(2003).Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S..Biomedicine American Sociological Review,68(2),161-194.
17. Davis-Floyd, Robbie(1992).Birth as an American Rite of Passage.Berkeley:University of California Press.
18. Douglas, Mary,Wildavsky, Aaron(1982).Risk and Culture.London:University of California Press.
19. Faundes, Anibal,Cecatti, Jose Guilherme(1993).Which Policy for Caesarian Sections in Brazil? An Analysis of Trends and Consequences.Health Policy and Planning,8(1),33-42.
20. Fiedler, Deborah Cordero(1997).Authoritative Knowledge and Birth Territories in Contemporary Japan.Childbirth and Authoritative Knowledge,Berkeley:
21. Gao、 Zi-ming(2008).剖腹產前應該考量的事.媽媽寶寶雜誌
22. Georges, Eugenia,Mitchell, Lisa M.(2000).Baby Talk: The Rhetorical Production of Maternal and Fetal Selves.Body Talk : Rhetoric, Technology, Reproduction,Madison:
23. Giddens, Anthony(1990).The Consequences of Modernity.Stanford:Stanford University Press.
24. Giddens, Anthony,Pierson, Christopher(1998).Coversations with Anthony Giddens.Cambridge Polity Press.
25. Hopkins, Kristine(2000).Are Brazilian Women Really Chossing Deliver by Cesarean?.Social Science and Medicine,51(5),725-740.
26. Horrigan, Terrence J.(2001).Physicians Who Induce Labor for Fetal Macrosomia Do Not Reduce Cesarean Delivery Rates.Journal of Perinatology,2,93-96.
27. Jhuang, Chimu(2005)。1/3台灣婦女愛剖腹 自然產好？ 剖腹產好？。嬰兒與母親雜誌
28. Jordan, Brigitte(1997).Authoritative Knowledge and Its Construction.Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives,Berkeley:
29. Klein, Michael C.(2009).Preventive Labor Induction-AMOR-IPAT: Much Promise, Not Yet Realized.Birth,36(1),83-85.
30. Lane, Karen(1995).The Medical Model of the Body as a Site of Risk: A Case Study of Childbirth.Medicine, Health and Risk: Sociological Approaches,Cambridge:
31. Lee, Sang-iI,Khang, Young-ho,Lee, Moo-song(2004).Women's Attitudes Toward Mode pf Delivery in South Korea: A Society with High Cesarean Section Rates.Birth,31(2),108-116.
32. Liamputtong, Pranee(2005).Birth and Social Class: Northern Thai Women's Lived Experiences of Cesarean and Vaginal Birth.Sociology of Health and Illness,27(2),243-270.
33. Martin, Emily(1987).The Woman in the Body: A Cultural Analysis of Reproduction.Boston:Beacon Press.
34. Potter, Joseph E.(2007).Women's Autonomy and Scheduled Cesarean Sections in Brazil: A Cautionary Tale.Birth,35(1),33-40.
35. Scheper-Hughes, Nancy,Lock, Margaret M.(1987).The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology.Medical Anthropology Quarterly,1(1),6-41.
36. Souza, Cecilia de Mello E.(1994).C-sections as Ideal Births: The Cultural Constructions of Beneficence and Patients' Rights in Brazil.Cambridge Quarterly of Healthcare Ethics,3,358-366.
37. Stoffle, Richard W.(1991).Risk Perception Mapping: Using Ethnography to Define the Locally Affected Population for a Low-Level Radioactive Waste Storage Facility in Michigan.American Anthropologist,93(3),611-635.
38. Wendland, Claire L.(2007).The Vanishing Mother: Cesarean Section and "Evidence-based Obstetrics".Medical Anthropology Quarterly,21(2),218-233.
39. 王文珠(2007)。剖腹產10大排行原因。媽媽寶寶雜誌，244，33-39。
40. 吳嘉苓(2007)。Explaining the High Cesarean-Section Rate in Taiwan: Surveying Women, Individualizing Risk, and Orientalizing Taiwan。Society for Social Studies of Science Annual Meeting，Montreal:
41. 吳嘉苓(2000)。產科醫生遇上迷信婦女？。性／別政治與主體形構，臺北=Taipei:
42. 徐金源(2004)。,Taipei:衛生署=Department of Health。
43. 鍾碧芳(2008)。剖腹產副作用的5大疑慮。媽媽寶寶雜誌，261，66-73。

1. 陳淑溫(2016)。台灣重複剖腹產婦女的決策過程。護理雜誌，63(5)，44-54。
2. 戴宏達,戴君倚,黃莉婷,李昭暉(2020)。臺灣初次懷孕婦女生產方式意願調查。助產雜誌，61，1-11。
3. 施麗雯(2019)。孕產照護邏輯：台灣女性的新生育選擇與共同修補。女學學誌：婦女與性別研究，44，1-46。
4. (2013)。生產中的現代性：科技信仰與科技侷限的競技場。臺灣人類學刊，11(1)，65-91。
5. (2018)。疾病與文化：李亦園先生對臺灣醫學人類學發展的貢獻。臺灣人類學刊，16(2)，7-45。