[[alternative]]The Development and Evaluation of a Birth Doula Program in Northern Taiwan

[[abstract]]面臨少子化及人性化親善生產環境需求日增，而國內又無陪產員服務之制度，為提升待產婦女照護品質及建立更完善之母嬰親善制度，以與國際接軌，故有必要研發台灣陪產員制度。本研究目的為研發北台灣陪產員制度並探討其初步成效，研究第一階段以立意取樣方式，分別以焦點團體方式探討醫護人員對於在醫院實施陪產制度之需求內容、陪產員角色功能及陪產員制度內涵，及以量性方法於產科門診探討孕婦對於陪產員的需求性，研究工具包括：孕婦對陪產員之需求問卷及醫護人員焦點團體訪談指引，以平均值、標準差、百分比等描述研究對象基本資料，以內容分析法進行焦點團體訪談逐字稿資料分析，以形成陪產員需求主題，第一階段研究顯示孕婦陪產的需求為65.3%，孕期的憂鬱情緒程度及待產信心對陪產需求程度有顯著相關，愛丁堡憂鬱量表總分每增加1分，陪產需求平均多0.121分（p=0.023），沒有信心比非常有信心者的陪產需求平均多3.332分(p=0.028)，孕期憂鬱程度越高及對於待產生產沒有信心者，對陪產的需求程度較高；第二階段依據文獻及第一階段之台灣陪產員需求評估成果，用修正式德菲法研發北台灣陪產員制度案，並具體落實於北市某醫學中心產科單位；第三階段採準實驗研究設計，依據個案意願共收案220位，分為研究組（124位）與對照組（96位），個案於產前門診自填基本資料與情境焦慮量表，實驗組於待產時接受陪產員陪產，而對照組則接受醫院常規照護，兩組個案於產後住院期間內自填基本資料、情境焦慮量表、產痛程度量表及產婦生產支持滿意度問卷，由主要照護個案生產之醫護人員各1位填寫「醫護人員對陪產員表現滿意度問卷」，以及陪產員自填「陪產員自我表現滿意度問卷」，顯示孕婦陪產的需求為58.7%，研究組及對照組在自然產比例達統計上顯著差異(87.9% vs 55.7% chi-square=23.3 p<0.001)，剖腹產比例在實驗組及對照組達統計上顯著差異(9.5% vs 39.7% chi-square=22.4 p<0.001)。[[abstract]]The objective of this research aims at the level of needs and influential factors to doulas from the pregnant women and effect of doula policy. Adopting a survey of purposive sampling from obstetric outpatients at two medical centers by delivering needs of doulas and Edinburgh Postnatal Depression Scale to those pregnant women with neither past medical history nor gestational complications. There were totally 340 pregnant women recruited for the survey. 65.3% hold the conviction that doulas are needed in order to support the needs of new born care skills, self-care techniques, physical support, psychological support, information giving, facilitating communications and peers’ support subsequently. Results concluded through the regressive analysis indicate that the level of depression during the pregnancy and labor confidence is significantly related to the need of doula. Every one-point increase in the depression score was associated with a 0.121-point (p=0.023) increase in the perceived need for a doula.Comparing those who with no confidence and those with apparent confidence, the gap in the need of doula may be as wide as 3.332 (p=0.028) in average. It proves that for those who are seriously depressed in pregnancy and no confidence in labor would certainly have a higher level of need for doula. Experiment case has significant difference in higher NSD rate(87.9% vs 55.7% chi-square=23.3 p<0.001) and lower c/s rate(9.5% vs 39.7% chi-square=22.4 p