| 摘要: | 目的：剖腹產率是世界各國用以評鑑醫院醫療品質的一項指標，台灣的剖腹產率自1995年至2005一直都在32~34%之間；又截至2006年4月底止，台灣新生兒生母來自大陸港澳或外國籍者佔總人數12.88%；因此本研究希望瞭解有關台灣外籍產婦在台灣的生產情況、生產方式之認知與其選擇生產方式之因素。
方法：本研究於2005年10月至2006年3月，以中部地區15家醫院之住院外籍產婦(原國籍非台灣籍且不論胎次與生產方式)、及其接生產科醫師為研究對象；共計收集產婦問卷400份，產科醫師問卷61份；利用羅吉斯迴歸分析(Logistic regression analysis)，探討影響外籍產婦選擇生產方式之相關因素。
結果： 本研究外籍產婦剖腹產率為23.60%；外籍產婦第一次生產年齡平均為26.87歲，原國籍以越南、其他國籍者選擇剖腹產之機率高於大陸港澳籍產婦；本研究中53.88%為初產；超過七成五者本次選擇自然生產，其原因為：「認為生產應順其自然」，其次是「醫師建議或鼓勵自然產」；在生產情況方面，本次剖腹產者年齡高於自然產者；生產住院費用上，自費給付生產費用之外籍產婦者選擇剖腹產比例高於自然生產者；選用剖腹產者有較高比例「對剖腹產的接受程度」表示完全接受。在產科醫師對生產方式認知方面，本次採用自然產接生之醫師同意「醫師未建議是造成產婦不願意嘗試自然產的主要因素」高於採用剖腹產接生者；其餘各項產科醫師基本特性對產婦生產方式並未達統計上顯著差異。
結論與建議：由本研究結果發現外籍產婦生產年齡普遍較台灣產婦年輕，不同國籍產婦剖腹產比例有所差異；除了醫療因素影響生產方式外，產婦本身選擇生產方式之意願，產科醫師是否有鼓勵產婦選擇自然產的態度亦是影響產婦決定生產方式的非醫療因素。因此，(1)加強大陸港澳與東南亞籍婦女的健康保健、(2)增加外籍產婦及其家屬宣導孕期和育兒知識的來源、(3)加強輔導外籍與大陸港澳籍婦女及其台灣配偶加入全民健保、(4)加強醫護人員對自然產的認知與態度、(5)推動鼓勵產科醫師及醫療院所採用自然產之政策，以期降低台灣總剖腹產率，並提升外籍產婦的醫療照護。
Objective: Cesarean section rate is a common criterion for medical quality on hospital accreditation in the whole world. The Cesarean section rate in Taiwan is around 32% to 34% from 1995 to 2005. 12.88% biological mothers were from China, Hong Kong, Macau or other countries in Taiwan. Therefore, this study tried to understand the situation of childbirth, methods of delivery and factors affecting delivery methods of immigration women in Taiwan.
Methods: 400 immigration women and 61 obstetricians from 15 hospitals in central Taiwan were chose from October 2005 to March 2006. Logistic regression analysis was used to discuss the effected factors for immigration women choosing delivery methods.
Results: The study found that the Cesarean section rate for immigration women was 23.60%. Their average age of first delivery was 26.87. Cesarean section rate for immigration women who were from Vietnam and other countries was higher than who were from China. 53.88% of immigration women were having primipara. More than 75% immigration women from this study chose virginal delivery. The reasons for choosing virginal delivery were “naturally methods for delivery” and “physicians advices or suggestions”. Age of Cesarean section parturient was higher than virginal delivery parturient. On the inpatient out-of-pocket payment part, immigration women who chose Cesarean section pay more than virginal delivery. On the question of “acceptance about Cesarean section”, Cesarean section women showed more acceptance than virginal delivery women. On the part of obstetrician’s acknowledgement, physicians chose virginal delivery at this time were more agree on “physicians did not suggest is the main factor that affect parturient’ willingness of virginal delivery” than physicians chose Cesarean section. There was no significant difference between other obstetricians’ basic characteristics and parturient’ delivery methods.
Conclusions and Suggestions: This study found that immigration women were younger than native primiparity in Taiwan. Different nationality women had different rate on Cesarean section. Except for medical factors, there are some other non-medical factors that will affect delivery methods, such as parturient willingness, obstetricians’ suggestions and attitude about virginal delivery. Therefore, in order to decreasing Cesarean section rate and increasing medical care on immigration women, we can bring following categories into actions: (1) improving healthcare on immigration women from China, Hong Kong, Macau or other countries, (2) increasing pregnancy and child care education on immigration women and their families, (3) improving immigration women and their related joining National Health Insurance, (4) improving medical staffs acknowledgement and attitude on virginal delivery, (5) bringing virginal delivery policies into action on obstetricians and hospitals. |
