[[alternative]]Correlation Between Pushing Skills, Pushing Perceptions, Second Stage Labor Duration, Postpartum Fatigue and Birth Satisfaction

[[abstract]]第二產程用力技巧於用力經驗感受、產後疲憊和生產滿意度之相關性研究所組別：護理助產研究所指導教授：高美玲教授研 究 生：黃玉青日 期：105 年 6 月 21 日研究背景生產過程是銜接產前產後的重要階段，生產所累積的疲憊甚至延續至產後，影響產後復舊、母親的安適及生活品質等健康指標，繼而影響產婦乳汁分泌、哺育母乳的意願和效能。而第二產程的用力的技巧能有效的減緩產後的疲憊，進而增加生產滿意度。研究目的主要目的為探討不同用力技巧與用力感受、產後疲憊及產婦生產滿意度之差異性，以及產婦於第二產程的用力感受與產後疲憊、生產滿意度的相關性。研究方法本研究採描述相關性研究，以方便取樣於民國 103 年 11 月至 104 年 10 月在北部某醫學中心醫院產後病房進行收案，共計收案人數為 382 位。採結構式問卷收集資料，研究工具包含基本人口學及產科學資料、用力感受量表、疲憊評量表以及生產滿意度量表，以 SPSS 18.0 統計軟體進行資料整理及分析，統計方法包含描述性統計、獨立樣本 t 檢定、皮爾森積差相關分析、多元線性迴歸、階層多元迴歸分析等推論性統計。研究結果產婦於第二產程採上半身直立姿勢用力對於生產滿意度（t = 2.28, p<.05）、整體滿意度（t = 2.64, p< .01）、護理人員滿意度（t = 3.06, p<.01）、醫師滿意度（t = 2.07, p<.05）的滿意程度高於平躺姿勢的產婦。採延遲性用力的產婦對於自我滿意度（t = -1.98, p<.05）高於立即用力的產婦。採開聲門用力的產婦比閉聲門用力的產婦在第二產程所花費的時間縮短 17.67 分鐘（t = 5.46, p<.001）。在用力感受經驗、生產滿意度與產後疲憊間之相關性方面，顯示產婦生產滿意度越高在用力經驗感受越良好（r=.46, p<.05），生產滿意度越高在產後疲憊的感受會越低（r = -.16, p<.05），用力經驗感受感受越正向在產後疲憊的感受會越低（r = -.22, p<.05）。用力經驗感受越好（β = -.22, p<.05）、年齡越高者 （β = -.19, p<.05）在疲憊感受會越低，有工作相（β = .13, p<.05）對於沒有工作的產婦，疲憊感受較高。在生產滿意度的相關因素方面，用力經驗感受越好（β = .45, p<.05）、第二產程時間越長（β = .15, p<.05）在生產滿意度越高；教育程度越高（β = -.13, p<.05）對生產滿意度較低。用力經驗感受為產後疲憊影響生產滿意度的中介變項（β = .45, p < .001）。不同用力姿勢、用力時機及不同用力方式對產後疲憊影響生產滿意度無調節效果。在不同用力方式為用力經驗感受影響生產滿意度之調節因子（β = -.15,p<.001），而不同用力姿勢、用力時機對產後疲憊影響生產滿意度無調節效果。結論及應用結果顯示第二產程用力技巧（包含直立式姿勢、延遲用力）能增加生產滿意度，而開聲門用力方式能縮短第二產程時間，於用力經驗感受越良好則產後疲憊的感受程度會越低、生產滿意度會越高，而產後疲憊的感受程度會越低則生產滿意度越高。期望產科照護者了解第二產程用力技巧運用時機的相關知識及技能，能實際的協助及教導產婦正確的用力技巧，進而幫助產婦發揮生產的本能。藉此提供產科醫師及護理助產人員對於婦女在第二產程有最適切且助益的照護，能助於她們有正向的生產滿意度。關鍵字：第二產程、用力技巧、用力經驗感受、產後疲憊、生產滿意度[[abstract]]Research background The delivery process is an important stage connecting the time before delivery and the time after delivery. The fatigue resulting from the delivery can last to the time after delivery, even affecting the healthy indexes such as postpartum recovery, mother’s comfort, and the living quality. Furthermore, it can affect the milk secretion of the delivery woman, the willingness and effect of breastfeeding. And it should be noted that the pushing skill of the second stage labor duration can effectively reduce postpartum fatigue, and enhance the birth satisfaction. Research purpose The main purpose was to explore the differences between different pushing skills and pushing perception, postpartum fatigue and the birth satisfaction of the delivery woman. In addition, it aimed to study the correlation between the pushing perception of the second stage labor duration, postpartum fatigue, and the birth satisfaction. Methodology This was a descriptive research design. Using a convenient sampling, we have recluded 382 women at the postpartum unit of a medical center hospital in northern Taiwan from November 2014 to October 2015. The structured questionnaire was used to collect data. And the research tools included the data of basic demography and obstetrics, Pushing Perception Scale, Fatigue Scale(Modified Fatigue Symptoms Checklist‚ MFSC), and the scale of birth satisfaction(Mackey Childbirth Satisfaction Rating Scale). SPSS 18.0 statistical software was used to conduct data management and analysis.In addition, the statistical methods included descriptive statistics, independent sample t test, Pearson product moment correlation analysis, multiple linear regression, hierarchical multiple regression analysis, all of which were inferential statistics. Results The satisfaction level of the delivery woman using the upright position in the second stage labor duration was higher than that of the delivery woman using a lying position in terms of birth satisfaction (t= 2.28, p<.05), overall satisfaction (t = 2.64, p<.01), the satisfaction of the nursing staff (t = 3.06, p< .01), and the satisfaction of the doctors (t = 2.07, p<.05). The self-satisfaction of the delivery women using delayed push (t = -1.98, p<.05) was higher than that of the delivery women using immediate push. The time the delivery women pushing with their glottis open during the second stage labor duration spent was 17.67 minutes less than the time the delivery women pushing with their glottis closed did (t = 5.46, p<.001).Regarding the correlation between pushing perception experiences, birth satisfaction, and postpartum fatigue, it showed that the higher the birth satisfaction of the delivery women, the better the pushing experience perception (r = .46, p<.05), and that the higher the birth satisfaction, the lower the postpartum fatigue ( r = -.16, p<.05), and that the higher the pushing experience perception, the lower the postpartum fatigue perception (r= -.22, p<.05). The better the pushing experience perception (β = -.22, p<.05), and the higher the age (β = -.19, p<.05), the lower the fatigue perception.Compared to the delivery women who were jobless, the fatigue perception of the delivery women who were employed (β = .13, p < .05) was higher. Regarding the related factors relating birth satisfaction, the better the pushing experiences (β = .45, p<.05) and the longer the second stage labor duration (β = .15, p<.05), the higher the birth satisfaction. The higher the education degree (β = -.13, p<.05), the lower the birth satisfaction. The pushing experience perception was the mediator (β = .45, p<.001) by which the postpartum fatigue affected the birth satisfaction. Different pushing positions, timing, methods had no adjusting effect on how postpartum fatigue affected the birth satisfaction. Different pushing methods were the moderator (β = -.15, p<.001) by which pushing experience perception affected the birth satisfaction. And different pushing postures and timing had no adjusting effect on how postpartum fatigue affected the birth satisfaction. Conclusion and application The results showed that the pushing skills in the second stage labor duration (including upright position, delayed pushing) can enhance the birth satisfaction. And the method of an open glottis can shorten the time of the second stage labor duration. The better the pushing experience perception, the lower the postpartum fatigue, and the higher the birth satisfaction. In addition, the lower the postpartum fatigue, the higher the birth satisfaction. The obstetrics professionals are expected to understand related knowledge and skills about the timing of the pushing skills in the second stage labor duration, and to practically help and teach the delivery women with correct pushing skills, and to help the delivery women enhance the natural delivery abilities. In this way, the obstetrics physicians, midwives and nursing staff can provide proper and helpful care to the women in the second stage labor duration, and help them to enjoy a positive birth satisfaction. Key words: second stage labor, duration, pushing skill, pushing experience perception, postpartum fatigue, birth satisfaction