初回帝王切開分娩の婦人の喪失と悲嘆過程の分析―経腟分娩の婦人との比較

Analysis of Loss and Grieving Process of Primary Cesarean and Vaginally Delivered Mothers

要旨

　帝切分娩では経腟分娩に比較してより多くの喪失を体験すると報告されている。本研究では，予定帝切の初産婦(帝切群16名)の喪失体験の内容とその原因および悲嘆過程の分析を目的とし，経腟の初産婦(経腟群16名)の喪失体験と比較検討した。帝切群は設定した8種の喪失のいずれかを体験し，中でも母親役割期待，出産機能の喪失および母親役割期待と出産期待の喪失の組み合わせを経腟群よりも有意に多く体験した。帝切群は経腟群に比較して悲嘆感情が長く続く傾向があり，出産期待の喪失の場合，帝切後における，日頃支持的存在であった夫や実母への悲嘆作業時の感情表出の有無が悲嘆感情の持続期間に影響をおよぼし，表出のなかった者に長期間持続することが統計学的に明らかになった。また予期的悲嘆をした者は喪失による実際の衝撃が軽減されていた．以上のことから，悲嘆作業への援助の重要性が示唆される．

Abstract

　The purpose of this study is to find the contents of loss and their causing factors and to identify the process of primiparous mother who delivered under cesarean delivery.

　Sixteen primiparass who were planned in advance to have cesarean birth were selected as a cesarean group, and sixteen primiparass who expected to have vaginal delivery were selected as a control group.

　Eight categories of loss suspected to be experienced by those pregnant mothers were losses of (1) maintaining life, (2) feeling of health, (3) control of body function, (4) ability to deliver normally, (5) expectation in terms of childbirth, (6) expected maternal roletaking, (7) body image, (8) control over self and situation.

　Cesaran mothers were interviewed at least five times, namely informed, on admission, after operation, on removal of suture. Vaginally-delivered mothers were also interviewed.

　As a result, it was found that the cesarean mothers have experienced certain established categories of loss, and more losses in relation to following categories satistically than vaginally-delivered mothers, expected maternal roletaking, ability to deliver normally, both expected maternal roletaking and expectation in terms of childbirth.

　Cesarean group tended to grieve for a longer time than vaginal group. In loss expectation in terms of childbirth, it was revealed satistically that whether or no cesarean group expressed their feelings for their husband or their mother, a usual supporter, after operation, affected the duration of grief, and no expression of their feelings prolonged the duration of griref. Anticipatory grief served as a saveguard against the impact of a real loss. Therefore it will be suggested that grief work was important.