無痛分娩における分娩第1期の進行を判断する助産師の非侵襲的観察項目：質的研究

First-Stage Painless Delivery Observational Items For Midwives: A Qualitative Study

抄録

【目的】無痛分娩における分娩第1期の進行を判断する助産師の非侵襲的観察項目を明らかにする。

【対象と方法】関東圏の5施設に勤務している助産師に半構造化面接を行い、得られたデータを質的帰納的に分析した。半構造化面接では無痛分娩の進行を判断するための非侵襲的観察項目について尋ねた。

【結果】15名の助産師から回答を得た。助産師が無痛分娩の進行を判断している観察項目として5カテゴリーと9サブカテゴリーが抽出された。【陣痛の変化に関する観察項目】は＜分娩監視装置または触診による陣痛周期の変化＞が、【産道分泌物の変化に関する観察項目】は＜産徴・分泌物の変化＞が、【児心音の変化に関する観察項目】は＜胎児心拍における一過性徐脈の出現＞が、【胎児の下降に関する観察項目】は＜胎児心音聴取部位の変化＞＜産婦の肛門圧迫感や胎児下降感の出現＞＜触診による胎児の回旋の確認＞が、【産痛と麻酔薬投与のバランスに関する観察項目】は＜産婦の痛みの再自覚＞＜麻酔薬の注入量＞＜麻酔薬導入後の痛みが取れた際の観察＞が抽出された。

【結論】助産師は無痛分娩の第1期の進行を5つの非侵襲的観察項目から判断していた。

【Purpose】 To clarify non-invasive observational items for midwives to determine the progression of the first stage of painless delivery.

【Methods】 The methodology and data obtained from the interview survey were qualitatively and inductively analyzed. A semi-structured interview was conducted with midwives working at five facilities in the Kanto region. In the semi-structured interview, observational items other than internal (pelvic) examination to determine painless delivery progression were investigated.

【Results】 Consent and answers were obtained from 15 midwives. Five categories and nine subcategories were extracted as observational items by which midwives determined the progression of labor in painless delivery. The five categories were as follows: (1) changes in labor cycle as shown on a delivery monitoring device (cardiotocometer) or palpation reflecting changes in pain of delivery; (2) changes in signs of labor discharge as an observational item reflecting changes in birth canal discharge; (3) changes in fetal heart rate waveforms on delivery monitoring devices (cardiotocometer) reflecting changes in embryocardia (fetal heart beat); (4) changes in fetal heart sound listening site, appearance of compression and fetal lowering sensation in maternal women, as detection of fetal rotation by palpation as observational items reflecting changes in baby head lowering; (5) and re-awareness of maternal pain, amount of injected anesthetics, and observing when pain is relieved after anesthetic introduction as observational items reflecting the balance between the pain of delivery and administration of anesthetics.

【Conclusions】 Midwives determined five noninvasive observational items for assessing progression of the first stage of painless delivery.