カンガルーケアを実施した母親の愛着と早期産体験の癒し

Maternal Attachment and Healing for Mothers through Kangaroo Care (Skin to Skin Care)

要旨

　本研究は，早期産の母親が実施するカンガルーケアは，早期産により傷ついた体験の癒しと子どもに対する愛着にどのような影響を与えているのかを明らかにすることを目的とした．対象は早期産となりカンガルーケアを3回以上実施した母親20名，介入はカンガルーケア（skin to skin care），測定した変数は，早期産体験の癒しと母親の愛着，および早期産体験の癒しと関連する気分である．データ収集時期は，介入前，介入2週間後，子どもの退院前の計3回である．データ収集は質問紙法による数量的測定と面接データによる質的測定を用い，これらの結果の類似点と相違点を検討した．

　数量的測定結果は，早期産体験の癒しの下位尺度，辛さのとらわれからの解放と現実の受けとめは，2週間後と退院前は介入前より有意に高かった（p＜0.03～p＜0.000）．これらの変化とやや異なり，自己の確かさは退院前のみが介入前より有意に高かった（p＜0.009）．母親の愛着は，いずれの時期にも有意な相違はなかった．早期産体験の癒しと関連する気分については，抑うつ－落込みは2週間後が介入前より有意に低く（p＜0.02），活気は退院前が介入前より有意に高かった（p＜0.01）．

　面接データでは，介入2週間後には，罪悪感と不確かさがやわらぎ辛さにとらわれることから解放されていた．辛さがやわらぐ要因として，カンガルーケアにより子どもの生きる力を感じ取ったことがある．また，退院前には，母親として子どもをケアする確かさを得て，ほぼ全員が辛かった早期産体験を肯定的に意味づけていた．これらは数量的測定結果と類似していた．一方，辛さにとらわれる程度はケースにより相違があり，その辛さは子どもに対する関係の取り方に影響していた．

Abstract

　The purpose of this study was to examine maternal attachment and healing for mothers through Kangaroo care (skin to skin care) in a Neonatal Intensive Care Unit. This study is one group repeated measure design, also interview data were compared with quantitative data.The convenience sample consisted of 20 mothers and their pre-term infants who were born weighing less than 2,500g. Evaluations were conducted before intervention, 2 weeks after intervention, and before discharge. Measurements used for this study were Healing of Preterm Child-birth (HPC), Maternal Attachment Inventory Japanese version (MAI-J), and Profile of Mood States (POMS).

　The results of multiple comparison indicated significant differences in healing of pre-term child-birth between before intervention versus 2 weeks after intervention in the subscale of Relief from distress (p＜0.000), and in Accept reality (p＜0.03). Furthermore these variables indicated significant differences between before intervention versus before discharge (p＜0.000-p＜0.001), while Self confidence indicated significant differences only between before intervention versus before discharge (p＜0.01). Maternal attachment indicated no significant differences at any time. The subscale of mood states of POMS indicated significant differences before intervention versus 2 weeks after intervention in Depression-Dejection (p＜0.02), and between before intervention versus before discharge in Vigor (p＜0.01).

　Qualitative data showed that Kangaroo care reduced the mother's feeling of guilt and uncertainty after 2 weeks of intervention. Because, through skin to skin care the mother felt the infant's movement and breathing, the infant's strength and well being was confirmed. Also, at discharge from the hospital, mothers were confident in being maternal caretakers of infants, and they judged their experiences to indeed be meaningful despite the initial threat of having a premature infant. However, one case was very sensitive and afraid to take care of her infant. Therefore, mothers who experience distress related to pre-term child-birth need support.