| 摘要: | 目的：我國的產科照護目前正面臨著外籍產婦的不斷增加，以及全體產婦的剖腹產率高居不下的兩個主要議題。過高的剖腹產率潛在著醫療資源浪費的問題，而偏低的剖腹產率則可能暗示著醫療照護的不足。本研究希望調查本國籍與外籍產婦在周產期相關背景及生產方式的差異情形，並瞭解造成不同族群間生產方式差異的主要因素。
方法：本研究以準結構式問卷佐以病歷資料分析，調查中部地區某區域教學醫院與基層診所，於2005年5月至2006年3月底所有符合收案對象的產婦。結果共收集有1465位產婦資料（包括本國籍1182位、大陸籍76位、東南亞籍207位）。首先以卡方檢定及變異數分析的統計方式，調查三個族群間背景資料的差異情形，然後利用羅吉斯回歸分析，探討造成不同國籍產婦生產方式差異的相關因素。
結果：在生產方式上，本國籍、大陸籍與東南亞籍產婦之剖腹產率分別為33.6﹪、26.3﹪及17.9﹪，三者呈現明顯差異。分析三個族群間在產婦生理特徵、新生兒特徵、分娩相關特徵與產婦相關社會經濟背景特徵等方面，發現本國籍產婦之年齡、體重、剖腹產次數均較外籍產婦為高，而相關的社會、教育、經濟背景也較好。在生產的結果方面，產婦與新生兒的健康狀況並無顯著差異。進一步分析造成剖腹產率差異之原因時，則顯示國籍別本身並非直接造成差異之因素。本國籍產婦較高的年齡層、BMI指數、孕期體重增加數、以及較多的先前剖腹產史，是造成剖腹率偏高的主要影響因素。而相關的經濟、社會背景等非醫療因素，則並未對不同國籍的產婦間，是否選擇剖腹生產造成有差異之影響。
結論：本國籍產婦因為分娩時年齡層較高、較為肥胖、孕期體重增加較多以及具先前剖腹產病史的比例較高，因此有偏高的剖腹產率。外籍產婦則由於年紀較輕、健康狀況良好，故相對的剖腹產率較低，醫療資源的耗用也較少。無論是本國籍、大陸籍或東南亞籍的產婦與新生兒，周產期健康結果都是一樣的良好。本研究顯示，產婦及醫師在決定是否採用剖腹產時並不受國籍別、社會經濟背景等因素干擾，可見我國對產婦照護的醫療可近性已有一定水準。因此，提倡剖腹產後自然生產、鼓勵生育年輕化、避免高齡產子、適度的體重控制是降低當今剖腹產率偏高的有效策略。
Aim: In Taiwan, today there are two major issues in obstetric medical care, the increase of immigrant mothers and the high prevalence of cesarean rate. There are potential overuse of medical resources in excess cesarean rate, whilst low cesarean rate may indicate insufficiency of medical care. The aim of this research is to survey the variations of perinatal background and delivery modes between Taiwanese and immigrant mothers, and to identify factors that affect the choice of delivery modes among different ethnics.
Methods: Using semi-structured questionnaire and medical charts data review, we survey maternal women from a regional teaching hospital and a clinic in central Taiwan from May 2005 through March 2006. We collected data from 1465 mothers (including 1182 Taiwanese mothers, 76 mothers from mainland China and 207 mothers from Southeast Asia). Chi-square test and ANOVA were utilized to describe the background variations of the three ethnic groups, logistic regression was used to further analyze the influencing factors that affect the choice of delivery modes in different ethnic groups.
Results: The cesarean rate of Taiwanese, mainland China and Southeast Asia are 33.6%, 26.3% and 17.9% respectively, which demonstrated significant difference in their choice of delivery modes. Futher analysis of the characteristics including maternal physiological characters, infant characters, clinical delivery-related characters and socioeconomical backgrounds of these ethnic groups were preceded. The age, body weight and cesarean rate are higher in Taiwanese mothers, accompanied with better social, educational, economical backgrounds. There are no significant differences between maternal and neonatal outcomes.Further study of the influencing factors on cesarean rate difference revealed that nationality is not the direct influential factor, but higher age, body weight and previous cesarean numbers of Taiwanese mothers. The non-medical factors such as social and economical do not significantly affect the choice of delivery mode of different ethnic mothers.
Conclusion: Due to higher age, body weight, perinatal body weight gaining and previous cesarean numbers of Taiwanese mothers, the cesarean rate is significantly higher than other groups. The cesarean rates of the relatively younger and healthier immigrant mothers are significantly lower, and also consumed less medical resources. The perinatal health outcome in three different groups are all in good condition. The present study revealed that in the medical decision making process of mother and obstetrician, nationality, social and economic factors contribute no significant effect on the selection of cesarean delivery. This result demonstrates the perinatal medical care accessibility of nowaday Taiwan is acceptable and adequate. Accordingly, promoting of virginal birth after cesarean delivery, encouragement of birth at younger years, avoiding elder maternity, proper control of body weight are all effective strategies to reduce the excess cesarean rate in Taiwan. |
