経腟分娩者の産褥早期の疲労感に影響を及ぼす分娩期および産褥早期の要因

Factors in intrapartum and early postpartum that are associated with fatigue in the early postpartum in women with vaginal delivery

抄録

【目的】産後の疲労感の軽減は女性にとって重要であるが、分娩期の処置やケアとの関連及び子育てへの移行期である産褥早期の影響要因に注目した研究は少ない。本研究では、経腟分娩者の産褥期の疲労感に影響を及ぼす要因の中でも特に分娩期及び産褥早期の要因を明らかにする。

【対象と方法】母児同室を行っている産褥5日目までの女性を対象とし、令和4年7月〜9月に、「産後の疲労感」尺度を用いてA病院にて自記式質問紙調査を行った。また診療録から分娩様式、分娩時処置等の分娩期情報及び産褥・新生児に関する情報収集を行った。「産後の疲労感」尺度を従属変数、分娩期及び産褥早期の要因を説明変数として重回帰分析にて影響要因を抽出した。大学倫理審査委員会およびA病院院長の承認を得て実施した。

【結果】197名の有効回答から、帝王切開54名を除く経腟分娩者143名を分析の対象とした。質問紙回答日の平均は、産褥2.99±0.51日で対象者の平均年齢は32.01±4.69歳、初産婦は55名（38.5％）であった。経腟分娩者の、産褥早期の疲労感に影響を及ぼす要因は、影響力の強い順に、「出産時の不安尺度合計点」、「無痛分娩」、「分娩歴」、「睡眠時間」、「既往歴・合併症」、「産痛緩和ケア」、「寄り添い」であった（ステップワイズ法、調整済みR²＝0.276、p＜0.001）。また、「寄り添ってくれた人」は複数回答で「助産師・看護師」が90.8％で最多であった。

【結論】経腟分娩者の産褥早期の疲労感を軽減するためには、特に初産婦や既往歴・合併症のある女性の、出産時の不安を軽減し、睡眠時間を確保するケアが重要であることが示された。無痛分娩は産後の疲労感を高める要因であった。一方、分娩中に効果的な産痛緩和ケアや助産師による寄り添いがあることで、分娩中の痛みや不安を軽減させることによって、産褥早期の疲労感を軽減できることが示唆された。

【Purpose】In light of the growing trend toward delayed childbearing, and an increasing number of women in the workforce, contemporary women confronted with the challenge of making a smooth transition to childcare while continuing to work after childbirth, it is important to consider ways to reduce postpartum fatigue. Although there have been many previous studies on factors related to fatigue in the postpartum period, few have examined the intrapartum and early postpartum periods. This study aims to clarify the factors during these periods that cause feeling of fatigue in the early postpartum period after vaginal delivery.

【Methods】The subjects were women up to the fifth postpartum day roomed with their baby at Hospital A. From July to September 2022, we conducted a self-administered questionnaire survey and collected relevant information from medical records. Questionnaires were distributed and were dropped into a collection box before discharge from the hospital.

Multiple regression analysis was conducted after univariate analysis with the "postpartum fatigue" scale as the dependent variable and factors in intrapartum and early postpartum as independent variables. The study was conducted with the approval of the University Ethics Review Committee and the Director of Hospital A.

【Results】Among197 valid responses 143 mothers birthing via vaginal delivery were analyzed after excluding C/Sections.

The mean date of response was 2.99±0.51day postpartum. The mean age was 32.01±4.69 years, and 55(38.5%) were primiparas. Factors inducing fatigue in the early postpartum period ranked in descending order of influence are anxiety during childbirth, labor analgesia, history of delivery, history/ complications, sleep duration, pain relief during labor and close attendance. (Stepwise method, adjusted R²=0.276, p＜0.001). The most common response in identifying the support figure was "midwife/nurse" (129 respondents, 90.2%), followed by "partner/family member in attendance at delivery".

【Conclusion】This study revealed the significance of reducing anxiety during childbirth and ensuring adequate sleep in early postpartum, especially for primiparas and women with history/complications. Labor analgesia was one of intrapartum factors that increased early postpartum fatigue. Moreover, effective pain relief and close attendance by midwives emerged as factors in reducing pain and anxiety during delivery, and in alleviating early postpartum fatigue.