Relationships between Social Supports, Maternal Confidence, Maternal Competence, and Maternal Parenting Stress in the Postpartum Period of Postpartum Women：Multilevel Analysis

前言：母育角色的發展會影響親子關係及孩子身、心、社會的發展，缺乏相關的育嬰知識與技能、母育信心及社會支持，會造成產後婦女在行使其母育角色行為時壓力的產生。母育角色的發展不但包含時間的變動，且其發展也不僅是以線性的變化。過去的研究設計多採橫段面，資料的處理也以傳統的迴歸分析，此研究方法不足以真實反應母育角色在發展所帶來母職壓力變化。為能真實反應這些變化，應完整的瞭解此變化趨勢及其影響因素。 研究目的：本研究主旨為瞭解產後婦女於出院時、產後滿一個月、滿兩個月及滿 四個月之社會支持、母育信心、母育能力及母職壓力的趨勢變化及其影響因素。 並比較不同產次產後婦女於產後早期之社會支持、母育信心、母育能力及母職壓 力的趨勢變化及其影響因素。 研究方法：研究設計採前瞻性、縱貫性研究設計，採立意取樣，於中部某醫學中心及衛生所，收集台灣籍、健康的產後婦女及其嬰兒，於產後出院時、滿一個月、滿兩個月及滿四個月，符合研究研究條件之有效樣本有305位，追蹤完整的資料共有209位，有效回收率為 68.5%。研究工具包括：社會支持量表、母育信心量表、母育能力量表及短版母職壓力量表。資料以SPSS/PC 13.0 window套裝軟體分析，以獨立t檢定比較初產婦與經產婦的基本資料、社會支持、母育信心、母育能力及母職壓力；以重覆量測單因子變異數分析比較不同時間的社會支持、母育信心、母育能力及母職壓力；Pearson 相關分析檢定同一時間及跨同時間的社會支持、母育信心、母育能力及母職壓力的關係；及以HLM多層次一般線性及分段線性成長模式檢定產後婦女於早期之社會支持、母育信心、母育能力及母職壓力的趨勢變化及其影響因素，並比較初產婦與經產婦於產後初期之社會支持、母育信心、母育能力及母職壓力的趨勢變化及其影響因素之差異。 研究結果：社會支持得分於出院時最高，之後隨著時間的增加而遞減。母育信心及母育能力的得分於滿四個月時最高，且隨著時間的增加而增加。母職壓力得分於滿一個月時最高，之後隨時間增加而遞減。整體而言，母職壓力與社會支持、母育信心及母育能力呈負相關，而社會支持、母育信心與母育能力之間呈正相關。於產後早期追蹤產後婦女的社會支持、母育信心及母育能力對母職壓力具有時間變化的軌跡，且不同產次其成長軌跡亦不同，其主要的影響因素是產後婦女自覺健康狀態、嬰兒的餵食型態、母育信心與母育能力，社會支持則無。 結論：本研究是國內第一篇採縱貫性研究設計及分層分析追蹤產後初期母職壓力的變化，其研究結果可彌補過去對產後婦女於產後早期母育角色發展及母職壓力的變化趨勢知識欠缺的部份，並驗證Rubin(1984)母育角色達成理論。在實務上可以促進護理人員為協助產後婦女的母育角色發展，並提供不同產次的婦女為改善其母職壓力，應採取不同的策略，以提昇產後婦女的照顧品質及增進其心理健康。Introduction: Development of the maternal role may influence mother-child relationship. Lack the related knowledge concerning infant care, maternal confidence, and social support may enhance the stress of postpartum women in performing the maternal role. Development of the maternal role not only is the variation of the time but also is a non-linear change. Previous study also performed by cross-sectional research design and using regression method for data analysis. However, type of this methodology is actually unable to reflect the real maternal parenting stress. Thereby, in order to precisely reflect this problem, realizing the trend of changes and its related factors is crucial. Aim: The aims of this study were to explore the trajectories change, the influenced factors, and the parity of social support, maternal confidence, maternal competence and maternal parenting stress for postpartum Taiwanese women during infant care within delivery hospital at 1st, 2nd, and 4th of postpartum period. Methods. This study was a prospective, longitudinal design and purposive sampling. Data were collected from 209 health postpartum Taiwanese women and their child at delivery hospital, 1st, 2nd, and 4th of postpartum period, and their infants come from a medical center and well-child clinics at health centers in central Taiwan. There were 305 women and their children to fit the research criteria and 209 women to response complete return the questionnaire. The response rate was 68.5%. The self-report questionnaire included the Social Support Scale, The Maternal Confidence Questionnaire, The Maternal Competence Scale and The SF-Maternal Parenting Stress Scale were used. Data were coded and analyzed with SPSS/PC 13.0 (+) for Windows and HLM. Student’s t-test and Repeated Measures ANOVA were applied to examine primiparous and multilparous women of the social support, maternal confidence, maternal competence, and maternal parenting stress in the same time and cross time. Pearson Correlation was used to examine the relationships between maternal parenting social support, maternal confidence, maternal competence, and maternal parenting stress. Multilevel analysis was used to examine the trajectories of change in social support, maternal confidence maternal competence and maternal parenting stress and to identify the factors that influenced the maternal parenting stress in the present study. Results: Results of this study showed that higher scores in social support were seen in hospitalization and were decreased by the time. The highest scores for maternal confidence and maternal competency were seen at 4th of postpartum period and the scores were increased by the time. The highest scores for maternal parenting stress were achieved at 1th of postpartum period and the scores were declined by the time. Accordingly, a negative relationship between maternal parenting stress and social support, maternal confidence, and maternal competency were seen in the present study. On the contrary, a positive relationship between social support, maternal confidence, and maternal competency was obtained in this current study. Monitoring maternal confidence, maternal competency and maternal parenting stress in postpartum women in early postpartum period indicated a piecewise trajectory changes, and this change was different accompanied by different parity. The major influenced factors for postpartum women were perceived health status, feeding type of the infant, maternal confidence, maternal competency and no influence was seen in social support. Conclusion: This is the first paper in studying the changes of the maternal parenting stress in early stage of postpartum women by using longitudinal research design and multilevel analysis in Taiwan. Our present data not only may provide some helpful information for postpartum women in realizing the development of early stage of the maternal role and the trend of maternal parenting stress, but also may verify Rubin’s theory of maternal role attainment. On the other hand, our finding is practically useful for nurses in promoting the progression of maternal role development, the quality of care and decreasing maternal parenting stress in postpartum women