助産師のレオポルド触診法に現れる熟練性

Expertise Which Appears in A Midwife's Method of Leopold Maneuvers

目的

　助産師が妊婦健康診査で実施しているレオポルド触診法という基本的な技術に焦点を当て、助産師の行為に現れている熟練性を明らかにする。

方法

　エスノメソドロジー法を参考とした探索的記述研究を用いた。具体的な方法として、5組に対し、妊婦健康診査場面でのやりとりを3台のデジタルビデオカメラで音声画像データを収集し、さらに助産師及び妊婦の判断・感情についてインタビューを実施した。分析は、音声画像データおよびインタビューデータを複数で質的に分析した。

結果

　助産師の熟練性として、【実施中の情報を捉える視線】【状況の知覚と援助の実施における同時性】【自身の尺度で差異を把握する診断】【流れるように無駄のない所作】の4つの特徴を見出した。

結論

　助産師は、レオポルド触診法の実施を多画的に情報を収集するひとつの手段とし、妊婦自身が身体に向き合い、愛着を形成できる場として活用していた。

Purpose

The purpose of this study was to elucidate expertise of expert midwives by observing and analyzing their Leopold maneuvers according to ethnomethodology.

Methods

Their bedside behavior was taken with a digital video camera and the audio and video data were analyzed by plural researchers. In addition, an interview was conducted with the midwives and examined pregnant women afterward.

Results

The participants were 5 expert midwives with 12-30 years of experience. The pregnant women were all primiparas and their weeks of pregnancy varied from 30 to 37 weeks. The length of time used for Leopold maneuvers was 1 min. 20 sec. to 2 min. 50 sec. This study confirmed the characteristics of the expertise of the midwives ; [line of sight to capture the information of the ongoing consultation] , [simultaneity of the implementation of the aid and the perception of the situation ] , [judgment of the difference in the measure of their own] and [in a fluid motion] .

Conclusion

Pregnant women's perception about minor troubles occurring with fetal development changed from "uncomfortable symptoms" to "joy toward childbirth". Although ultrasonic diagnosis is now popular and the chance of palpation is decreasing, the significance of performing Leopold maneuvers was confirmed.