産科病院を退院間近の初産婦の母乳育児に対する思いと助けになったと感じた看護者の働きかけ

Feelings about Breastfeeding of Primiparas Just before Leaving the Maternity Hospital and Actions of Nurses and Midwives They Felt Most Helpful

要　　旨

　目的：産科病院を退院前の初産婦の母乳育児に対する思いと、助けになったと感じた看護者の働きかけ を探索する。

　方法：退院予定にある産褥4〜5日目の初産婦12名に、半構成的面接を行った。

　結果：「思い」の184コードから、嬉しさや母親役割の実感、悲しさや諦め、授乳を義務感と捉えるなど多様であり、これらの思いには、母乳育児の習得状況や身体的苦痛といった現状の影響だけでなく、出産前からの母乳育児への希望やイメージとの違い、退院に向けての思いなどとも関連していた。「助けになった働きかけ」は、176コードから、母親に向けた励ましや承認、安心を与える声掛けや、体調などを配慮した母親自身に向けた支援などがあげられた。知識・技術面では、個々の時期や授乳状況に合わせた指導や、対象に合わせた知識の提供などであった。

　結論：産科病院を退院間近の初産婦の母乳育児への思いは複雑である。それに対しての助けとなる働きかけは、看護者の行動や態度に関するものが多かった。

　Objectives: To explore the feelings about breastfeeding of primiparas just before leaving the maternity hospital and the actions of nurses and midwives they felt most helpful.

　Method: A semi-constitutive interview was conducted on 12 primiparas who were on the 4th to 5th day of puerperium and for whom discharge from the hospital was planned.

　Results: Their feelings selected from 184 codes of “feelings” were various and included actual sensations of joy and their role as a mother, sadness and resignation, and a feeling of obligation on breastfeeding. These feelings of the primiparas were related not only to the influence of actual conditions such as acquisition of breastfeeding skills and physical affliction but also to the differences from the hope and images of breastfeeding they had had before delivery and their feelings toward discharge from the maternity hospital. The “helpful actions” selected from 176 codes included encouragement and approval to the mother, talking to the mother to give her a feeling of ease, and support to the mother by paying attention to their physical conditions. The actions included, in terms of knowledge and techniques, guidance suitable for the respective timings and breastfeeding conditions and the offering of knowledge tailored to the respective subjects.

　Conclusions: The feelings of primiparas just before discharge from the maternity hospital were complicated. Actions helpful to them were mainly related to the behaviors and attitude of nurses and midwives.