妊娠期にがんと診断された妊産婦とその家族に実施された助産ケアに関する記述研究

Descriptive Study of Midwifery Care Provided for Women Diagnosed with Cancer during Pregnancy and Their Families

要旨

　目的：妊娠期にがんと診断された妊産婦と家族に実施された助産ケアを記述することである．

　方法：助産師7名に非構造化インタビューを行い，ナラティヴ分析を行った．

　結果：15エピソードのテーマ及びサブテーマ，横断的比較検討により4つのテーマ（「妊娠の継続/中断，がん治療方法の選択，授乳に関して女性の選択を後押する」「妊娠・出産に伴いがん治療を受ける（受けない）女性にお母さんとして関わる」「がん治療と妊娠・出産・育児を連続したスパンで捉え家族全体にもたらす影響を捉えながら対応する」「複数の診療科や職種を超えて同じ方向を向く中で女性と家族に関わる」）が明らかになった．

　結論：助産師の実践は，妊産婦と新生児のケアという助産ケアの価値観に基づき，女性を母親として見るという特徴があった．これらは妊娠期がん女性と家族へのケアにおける複数の診療科，職種間での連携，協働，支援をさらに進めていくうえで重要である．

　Purpose: This study is aimed at describing midwifery care provided for women with cancer diagnosed in pregnancy and their families.

　Methods: Unstructured interviews were conducted with seven midwives who had experience of assisting women diagnosed with cancer. The data was analyzed using the narrative approach.

　Results: Concerning 15 episodes, we found subthemes, based on which one theme per one episode was identified. Having analyzed the episodes, subthemes, and the themes in a cross sectional manner, we clarified that there are four themes that represent midwifery care: Supporting women so they can make the best decision based on a wide range of information that provides a balanced perspective, when debating with themselves whether or not to continue a pregnancy, to undergo cancer treatment, or to breastfeed; perceiving the women as mothers who would or would not undergo cancer treatment during their pregnancy; understanding their thoughts during the continuous span of cancer treatment, pregnancy, delivery to as far as the period of childcare and dealing with the women and their families considering the impact on the whole family; and taking care of the women and their families, while working with multiple departments and professions and going in the same direction.

　Conclusion: Midwives' practice was characterized by viewing women as mothers, based on the midwifery care values of maternal and newborn care. Their perspective and practice of having regard for women as mothers is important to further support the women and families through enhanced collaboration and cooperation among multiple departments and professions.