帝王切開で出産した女性の妊娠中から産後1か月までの心理的プロセス—覚悟と納得

The Psychological Processes of Women Who Underwent Cesarean Sections Experienced from during Pregnancy to One Month after Delivery: “Making Up My Mind to Have a Cesarean Section” and “Consenting to a Cesarean Section”

要旨

　目的：帝王切開で出産した女性の，妊娠中から産後1か月までの帝王切開に対する心理的プロセスとその影響要因を明らかにし，看護支援への示唆を得ることを目的とした．

　方法：グラウンデッド・セオリー・アプローチを用い，帝王切開後の女性18名に半構造化面接を行って分析し理論化を試みた．

　結果：女性は帝王切開に対する〈心づもり〉と〈意味づけ〉のプロセスをたどることで，帝王切開に対する〔覚悟〕と〔納得〕に至る．それらは〈帝王切開の可能性の認識〉をした時点から始まり，〈手術への恐怖〉や〈自然分娩への未練〉は阻害要因，医療者や経験者とのやりとりは促進要因となる．〈意味づけ〉は分娩後にも続く．緊急帝王切開では〈心づもり〉や〈意味づけ〉ができないまま手術に臨む場合があるが，〔納得〕するためには，分娩後に〈意味づけ〉が行われる．

　考察：帝王切開に対する〔覚悟〕と〔納得〕の理論を軸に，〈心づもり〉と〈意味づけ〉を促すような具体的な看護支援が示唆された．

　Objectives: This study aimed to theoretically explain the psychological processes of women who underwent cesarean sections experienced from during pregnancy to one month after delivery and to determine influential factors for providing appropriate nursing care.

　Methods: Semi-structured interviews with 18 Japanese women who had undergone cesarean sections were analyzed using a grounded theory approach in order to construct a theory.

　Results: Women who had undergone cesarean sections could make up their minds to have cesarean sections through the process of “preparing for a cesarean section.” They could also consent to cesarean sections through “finding meaning in a cesarean section.” However, there were factors inhibiting or promoting these two psychological processes, which often began with an “awareness of a possibility of a cesarean section.” “Being afraid of surgery” and “still feeling attached to a natural birth” were inhibiting factors, while interactions with health care workers and other women who had had cesarean sections were promoting factors. The process of “finding meaning in a cesarean section” continued after delivery. An emergency cesarean section sometimes meant that a woman could not complete both of these processes. In such cases, a woman would follow the process of “finding meaning in a cesarean section” after delivery, in order to arrive at a point where she could consent to one.

　Discussion: Based on the dual process theory of “making up my mind to have a cesarean section” and “consenting to a cesarean section,” nursing interventions that accelerate the two psychological processes were suggested.