分娩期に院内助産から産科病棟での出産へ移行した産婦への助産師の支援

Abstract

目的：分娩期に院内助産から産科病棟での出産へ移行した産婦への助産師のケアの方向性や支援を明らかにする。方法：助産師10名を対象とし半構造化インタビューを行い、質的帰納的方法で分析した。結果：10個のカテゴリーと25個のサブカテゴリーから構成されていた。院内助産からの転棟（移行）を受けた助産師は、【いつ急な院内助産からの転棟があってもいいような準備】を行い、基本的となる支援として【これまでの経過や産婦の思いへの継続ケア】、【新たに信頼関係を築き、慣れない場でのリラックスを促す】、【疲れている産婦や家族を気遣い、気持ちを前向きにさせる】、【転棟して状況が変わったため、最終目標を一緒に確認し達成を目指す】、【産婦が自分の力で産むと感じられる支援】、医療介入を意識したケアでは【状況や必要な医療介入についての理解・納得度を確認する】、【満足度の高い医療介入となるように医師と連携する】ことを行っていた。【産科病棟の特性による課題がある】ことを感じながらも、【お産が育児に影響することを見通して、より良い出産体験となるように関わる】ことをゴールとしていた。考察：日頃から院内助産からの急な転棟（移行）に備えての準備が支援の土台として重要と考えられた。また出産体験が母子の将来に影響を及ぼすため、良い出産となる支援が必要と考えられた。更に産科病棟の特性による課題から、助産師聞の更なる協力等の必要性が示唆された。

PURPOSE: To clarify midwives' views on care and support provided by midwives to parturient women transferred in the intrapartum period from an in-hospital midwifery center to a maternity ward. METHOD: Semi-structured interviews were conducted with 10 midwives and answers were qualitatively and inductively analyzed. RESULTS: The analysis produced 10 categories and 25 sub-categories. Midwives who received transferred patients from in-hospital midwifery centers made “preparations to accommodate patients even if they had suddenly been transferred from an in-hospital midwifery center.” As basic support, midwives “provided continuous care for the parturient woman's progress so far and her feelings,”“built a new relationship of trust and encouraged relaxation in an unfamiliar place,”“ showed consideration for the exhausted parturient woman and her family and fostered a positive attitude,”“confirmed the end goals together with the parturient woman to achieve these goals as a result of the change in situation due to the transfer,” and “supported the parturient woman in feeling able to give birth under her own strength.” Midwives also “confirmed the degree of understanding of, and consent for, the situation and necessary medical intervention” and “coordinated with physicians to ensure highly satisfactory medical intervention” in their provision of care with medical intervention in mind. Furthermore, despite feeling that “issues arising from the characteristics of maternity wards exist,” midwives aimed to “provide care to ensure a better childbirth based on the outlook that childbirth affects subsequent childcare. ”DISCUSSION: Regular preparations for sudden transfers from in-hospital midwifery centers appeared to be an important foundation of support. Furthermore, because the experience of childbirth affects the future of the mother and child, support to ensure a good birth was considered necessary.