中期人工妊娠中絶と出産が同時進行する状況における助産師の中絶ケア

Abortion-care provided by midwives under the situation where an artificial abortion and a childbirth are concurrently proceeding

抄録

【目的】わが国でもNIPTが導入され、これまで選択的人工妊娠中絶を扱ってこなかった施設が、中期中絶を扱わざるを得ない事態が起きている。本研究では、NIPT導入施設において、同一エリアのなかで中期中絶と出産が同時に分娩進行するときに、助産師が提供できる中絶ケアを明らかにすることとする。

【対象と方法】研究デザインは、グループインタビュー法を用いた質的記述的研究とした。研究期間は2017年7月12日〜9月4日で、対象はNIPT導入施設に勤務する助産師とした。インタビュー内容は、中期中絶と出産が同時進行する状況で提供したい中絶ケア、それを実現するうえでの困難感と方策とした。得られたデータはグループごとに独立して分析し、提供したい中絶ケアを示すデータを抽出し、重要カテゴリーを生成した後、体系化した。本研究は、東邦大学看護学部倫理審査委員会の承認を受けている（承認番号28032）。

【結果】本調査へは2施設から協力意思が得られ、A病院6名、B病院3名が調査に参加した。中絶ケアには《中期人工妊娠中絶の産婦や家族へ直接はたらきかけるケア》、【中期中絶の受容を促す助産師の関わり】をはじめとする心理的ケア、中期中絶の【産婦の分娩室での滞在時間の短縮】を図るといった間接的ケア、《中期人工妊娠中絶後の先を見据えた継続的ケア》と4つの体系が抽出され、20の重要カテゴリー、69の重要アイテムが集約された。

【結論】中期中絶と出産が同時進行する状況では、中期中絶の産婦の分娩室での滞在時間を短縮し、中期中絶を受容できるような関わりが助産師によってなされており、グリーフケアも必要であることがわかった。さらに中期中絶後には、先を見据えた継続的ケアが必要であるが、中期中絶を選択した女性にはさまざまな背景があるため、グループプライマリーをとることで、統一したより良いケアが提供できると考える。

【Purpose】NIPT (non-invasive prenatal genetic testing) was introduced also in Japan and, consequently, institutions where a selective artificial abortion has never been carried out are now faced with having to perform artificial abortions. The purpose of this study is to clarify better care that midwives can provide to the women who selected an artificial abortion under the situation where an artificial abortion and a childbearing delivery are concurrently proceeding in the same area of NIPT-introduced institutions.

【Methods】The study design is a qualitative descriptive research using group interviews conducted from July 12th to September 4th, 2017. The subjects were midwives working in NIPT-introduced institutions. The interview contents were “Desirable abortion-care to be provided in the delivery room where an abortion and a delivery are concurrently proceeding” and “Midwife's feeling of difficulty in achieving such care and the countermeasure”. The data obtained were analyzed independently for each of the interview groups to extract data showing desirable care to be provided and, then, important categories were assorted to finally systematize. This study was approved in advance by the Ethics Committee of faculty of Nursing, Toho University (Approval No. 28032).

【Results】Participants in the interview were 6 midwives from Hospital A and 3 from B that agreed to the study cooperation. As for abortion-care, 4 systems were extracted such as “Care to be provided directly to the women who had an abortion and her family”, “Psychological care” including [Midwife's involvement to encourage the women to accept the abortion], “Indirect care” including [Shortening of sojourn time in the delivery room], and “Continuous care foreseeing the post-abortion progress”, and 20 important categories and 69 important items were assorted.

【Conclusions】It was clarified that, under the situation where an abortion and a delivery are concurrently proceeding, midwives had implemented shortening of sojourn time in the delivery room for the women who had an abortion and involvement in the women to accept the abortion. Thus, it was found that grief-care is also necessary. In addition, “Continuous care foreseeing the post-abortion progress” is necessary after abortion, but it is considered that integrated better care can be provided by employing a group primary system because the women who selected an abortion have various backgrounds.