Support for women during the subsequent childbirth after losing a child due to childbirth related malpractice
出産にかかわる医療過誤により児を喪失した女性の次子出産への支援

Yumiko YAMAZAKI, Ryoko KATO
2017 Journal of Japan Academy of Midwifery  
Support for women during the subsequent childbirth after losing a child due to childbirth related malpractice -Relevant factors and midwives' awareness in the desirable care of women- 以下,児を喪失した女性とする)の心理やニーズ に対する助産師の認識,施設での支援の現状と課題を明らかにし,児を喪失した女性への望ましいケア に対する助産師の認識に関連する要因を検討する。 対象と方法 分娩を取り扱っている全国の施設から 145 施設を無作為抽出し,調査協力の依頼をした。承諾が得ら れた 18 施設に勤務する助産師全員(251 人)に,自記式質問紙調査を実施した。調査内容は,児を喪失 した女性に対する知識,経験,理解度および認識などの支援に関するものとした。本研究は量的記述研 究デザイン,関係探索型横断研究であり,Spearman の順位相関係数,共分散構造分析を用い分析した。 結 果 139 人(回収率
more » ... .4%)から回答が得られた。児を喪失した女性に対する知識や経験は少なく,次子出 産ケア経験のある助産師は 7 人 (5.0%)であった。児を喪失した女性の次子出産に必要な支援の理解は, 全員が肯定的な認識をもつ項目がある一方, 「医療過誤や喪失した児のことをよく知っている医師,助 産師が立ち会う」 という項目は,68 人 (51.5%) が否定的な認識をもっていた。児を喪失した女性への望 ましいケアに対する助産師の認識に関連する要因については, 「ネガティブな心情」よりも「必要な支援 の理解」 で 「望ましいケアに対する認識」 の標準化係数 (各々−0.12,0.67) が高かった。 結 論 児を喪失した女性の心理やニーズに対しては, 「医療過誤や喪失した児のことをよく知っている医師, 助産師が立ち会う」という項目において,過半数以上の助産師が否定的な認識をもっていた。このよう な認識に至る助産師の心理について要因を含め検討する必要がある。児を喪失した女性の次子出産に対 2016 年 5 月 16 日受付 2017 年 4 月 24 日採用 * 川崎市立看護短期大学 (Kawasaki City College of Nursing) 日本助産学会誌 J. Abstract Objectives This study aims to elucidate midwives' awareness of the psychology and needs of women during childbirth after losing a previous child (hereinafter, "women who lost a previous child") due to childbirth related malpractice, to elucidate the current situations and issues of support at facilities, and to examine the relevant factors for awareness of midwives in supporting the desirable care of women who lost a previous child. Materials and Methods A total of 145 facilities among the hospitals in Japan that handle childbirth were contacted at random, and were asked to participate in this survey. Self-administered questionnaires were distributed to 251 midwives working at 18 facilities who consented to participate in our study concerning the following points: knowledge, experience, understanding, and awareness about subsequent childbirth in women who had lost a previous child. This is a quantitative descriptive, and a relationship exploratory cross-sectional study. Analysis was performed using Spearman's rank-correlation coefficient and analysis of covariance structure. Results We obtained 139 responses (55.4% collection rate), of which there were a few midwives who had knowledge and experience about women who lost a previous child, and 7 midwives (5.0%) who had the experience of caring for women during subsequent childbirth. With regard to the understanding of necessary support for the subsequent childbirth in women who lost a previous child, although there were categories for which all the respondents shared affirmative awareness, 68 midwives (51.5%) indicated negative awareness for the following category: "physicians or midwives who are well-acquainted with malpractice or the cases where children were lost due to malpractice attend the subsequent childbirth". Concerning the relevant factors of midwives' awareness in the desirable care of women who lost a previous child, "more than negative feeling," the standardized coefficient from "understanding of necessary support" to "awareness of the desirable care" of women who lost a previous child was as high as −0.12 and 0.67, respectively. Conclusion With regard to midwives' awareness of the psychology and needs of women who lost a previous child, more than half indicated negative awareness for the following category: "physicians or midwives who are well-acquainted with malpractice or the children who were lost because of malpractice attend to the subsequent childbirth." It is necessary to perform an investigation including factors related to the psychology of midwives that led to such an awareness. As for the current situations and issues of support at facilities for subsequent childbirth in women who lost a previous child, midwives' knowledge and experience about women who lost a previous child and experience in subsequent childbirth care are limited. Thus, midwives must make efforts to understand the issues by utilizing their knowledge and experience. Regarding the relevant factors related to midwives' awareness in the desirable care of women who lost a previous child, the results suggest that improving the "understanding of necessary support" for women who lost a previous child would lead to "awareness in the desirable care."
doi:10.3418/jjam.31.88 fatcat:rltmm7iolfgjzped6xgkp56xtu