[[alternative]]Efficacy of Antenatal Perineal Massage on Birth Outcome for Primiparous

[[abstract]]本研究旨在探討孕期會陰按摩對初產婦生產結果之影響及婦女對執行會陰按摩感受。採質量混合研究設計，收案場域為北部某區域教學醫院，於婦女懷孕週數介於34～36週並符合收案條件時，向婦女解釋研究目的及收案方法後，同意參與研究後予以收案。以隨機分派的方式將研究對象分為實驗組與控制組，實驗組除了接受一般的孕產前照護及指導產前運動中的凱格爾運動之外，再特別指導孕期會陰按摩運動，此按摩運動是將手指伸入陰道內約2.5~4公分，並向下及往兩側施壓直到有輕微灼熱感和被延展的感覺，可自我執行或由配偶協助執行，每週至少兩次以上，每次至少10分鐘。控制組則接受一般的孕產前照護，並教導產前運動中的凱格爾運動。研究結果在量性資料以SPSS15.0版套裝軟體進行統計資料的處理及分析；質性資料以內容分析法，指將一段文字所存在的特定的字句或概念加以歸類。本研究共接觸107位初產婦，實際完成收案人數為45位。研究發現若孕期婦女每週至少執行會陰按摩兩次以上，可有效降低會陰切開率（p< .05），但在探討婦女發生嚴重三～四度會陰撕裂傷率、第二產時間、產後會陰傷口疼痛指數方面，實驗組比控制組雖然有較好的生產結果，但卻未達到滿意的顯著差異性。在婦女執行會陰按摩感受方面，婦女會經歷四個主要過程：（一）追尋理想的生產過程及結果；（二）努力克服按摩過程的不安與困擾；（三）滿意於夫妻彼此間親密感增加VS.擔憂夫妻間之性神秘感消失；（四）評價會陰按摩的結果。發現孕婦執行孕期會陰按摩的意願、持續性與配合度和個人的動機、身體狀況以及配偶的態度和支持等皆會影響執行會陰按摩的次數，因此，若醫護人員能客觀向婦女或其配偶說明執行會陰按摩的好處、過程中可能感受到的會陰變化及針對婦女可能會有的疑慮做解釋及給予相關指導，相信更能提高婦女在孕期會陰按摩的執行度。關鍵字：初產婦、孕期會陰按摩、生產結果、孕期會陰按摩感受[[abstract]]This study explores the effectiveness of perineal massage for primiparous women and how they feel about performing perineal massage. It is a mixed-method study with the enrollment in a regional teaching hospital in northern Taiwan. Women with a gestation between 34 and 36 weeks who met inclusion criteria were explained the purpose of the study. Once their consent to participation was obtained, they were enrolled in the study. Participants were randomized into either the experimental group or the control group. Besides general prenatal care and Kegel exercises, participants in the experimental group were educated on how to massage their perineum during gestation. To do the massage, women themselves or their spouses needed to place their fingers 2.5 to 4 centimeters inside the vagina and press downward and to the sides at the same time until a slight burning, tingling and extending sensation was felt. The massage was performed at least two times a week and 10 minutes each time. On the other hand, women in the control group only received general prenatal care and were taught how to do Kegel exercises. For quantitative data obtained in the study, statistical processing and analysis were performed using the SPSS 15.0 software package. Content analysis was performed on qualitative data. Specific sentences or concepts in a paragraph were categorized. A total of 107 primiparous women were approached and 45 of them were actually enrolled in the study. It was found that when pregnant women massaged their perineum at least two times a week, it could effectively reduce the incidence of episiotomy (p< .05). However, in terms of Degrees 3 and 4 perneal laceration, duration of the second stage of labor, and postpartum perineal wound pain index, despite the better results in the experimental group, no satisfactory significant difference was observed between the experimental and control groups. In terms of the feelings of the women performing perineal massage, it comprised four major themes: (1) pursuit of an ideal delivery process and result; (2) efforts to overcome discomfort and disturbance during massage; (3) increase in the satisfaction of marital intimacy Vs concern over disappearance of marital mysteriousness, and (4) evaluation of the results of perineal massage. It was found that the willingness of pregnant women to perform gestational perineal massage, the persistence and cooperation, their personal motives, physical status, and the attitude of and support from their spouse all affects the number of times perineal massage was performed. Therefore, it is believed that the compliance of women in performing perineal massage during pregnancy can be better improved if healthcare professionals objectively explain the benefits of perineal massage, possible changes to the perineum during massage and possible concerns women may have to the pregnant women and their spouses with proper instructions. Keyword: primiparous women; perineal massage; birth outcomes; perception of perineal massag