2．透析患者の出産経験の認識―後方視的検討

　本研究の目的は，透析患者の出産経験の認識を聞き取り調査により後方視的に明らかにすることである．対象は1986年から2005年の19年間に出産経験した17名．調査時の平均年齢41.1歳，20年以上の長期透析者が26.7％を占め，出生児の8割が年齢相応の発育を遂げていた．出産時の透析歴6.7年，在胎週数は31.9週，出生体重は1,596.6gであった．約6割は望んだ妊娠であり，3割が不妊治療の経験者だった．最初に妊娠相談をした人の7割は妊娠を肯定する反応を示し，妊娠継続の迷いをみると，2000年以降群はそれ以前に比べ有意（χ² = 4.65，P ＜ 0.1）に迷ったと認識していた．妊娠継続にかかわる情報提供は，1996年以前群では医師から，2000年以降群では自分で検索の割合が高く，妊娠生活を2000年以降群は主体的に受け止めたとする割合が高かった．出生児との早期接触（χ² = 3.43，P ＜ 0.1），母乳哺育の経験（χ² = 4.73，P ＜ 0.05）は2000年以降群で有意に高かった．妊娠・出産の経験は9割が豊かな経験と認識し，子どもの存在は社会復帰や生きがいの対象であると全員が認識していた．多様な困難を経験しても，子を得た出産は豊かな経験であり，わが子の存在は社会復帰の重要な指標であることが示唆された．

　The purpose of this study is to retrospectively examine the birth experience and perceptions of dialysis patients by interviews. Subjects were 17 women who had given birth over a 19-year period from 1986 to 2005. Their mean age during the study was 41.1 years, and women on dialysis for 20 years or longer accounted for 26.7％of the total. Eighty percent of the infants they bore achieved age-appropriate growth. The duration of dialysis at delivery was 6.7 years, gestational age was 31.9 weeks, and birthweight was 1,596.6g.

　More than half of the women wished to be pregnant, and 30％had experience with fertility treatment. Seventy percent of women consulting on pregnancy responded positively to news of their pregnancy. In terms of uncertainty over continuing with the pregnancy, the group who gave birth after 2000 considered themselves significantly uncertain (χ² = 4.65,P ＜ 0.1) in comparison to the group who gave birth prior to that. Provision of information regarding continuing the pregnancy was done by a physician in the group who gave birth prior to 1996, while a high proportion of the group who gave birth after 2000 searched for information themselves. A high proportion of the group who were pregnant after 2000 actively accepted the information. The group who gave birth after 2000 had a significantly higher amount of early contact with the infant after birth (χ² = 3.43,P ＜ 0.1) and breast feeding (χ² = 4.73,P ＜ 0.05). Ninety percent of the women considered their experience with pregnancy and childbirth to be a rich one; all of the women considered having a child to be a reason for living and reintegration into society. A successfully giving birth is a rich experience despite the various difficulties encountered. Results suggested that a woman having a child is an important indicator for social reintegration.