初次剖腹產後的生產方式：臺灣產科醫生的決策策略

Mode of Birth Following a Primary Caesarean Section: Taiwanese Obstetricians' Decision-Making Strategies

10.6518/TJOM.2015.57.6

陳淑溫(Shu-Wen Chen)；鄭博仁(Po-Jen Cheng)

質性研究 ； 重複剖腹產 ； 剖腹產後陰道生產 ； 生產方式決策

助產雜誌

57期（2015 / 12 / 01）

55 - 69

繁體中文

先前剖腹產佔臺灣剖腹產率原因的第一位。近二十年來，臺灣婦女的生育多由產科醫師主導，因此本研究目的乃在探討臺灣產科醫生對初次剖腹產後再度懷孕之婦女其生產方式決策策略。本研究採質性研究，於北臺灣某醫學中心收案，共有11位產科醫生接受深度訪談，資料分析乃採紮根理論之持續比較分析法。研究結果發現產科醫生的決策策略受到內在因子（支持剖腹產陰道生產的態度及執行剖腹產陰道生產的信心）及外在因子（醫療糾紛、健保給付的政策、醫院對剖腹產後陰道生產的政策、24小時的指定醫師制以及婦女的選擇）的影響。其中醫療糾紛是最常被產科醫師描述的影響因子。產科醫師決策策略包括採取獨斷策略或諮商策略。7位資淺的醫師與2位資深的醫師傾向建議或直接執行重複剖腹產；2位主任級資深的醫師會採取四個諮詢步驟來協助婦女做生產決策，包括詢問婦女的意願，告知另類選擇，簡單解釋或分析風險，以及讓婦女自己做決定。安全和風險處置是主要影響產科醫師協助曾有初次剖腹產後懷孕婦女做生產方式選擇的主要因素。

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