臺灣博碩士論文加值系統

本研究目旨在比較準父母之生產期望與生產經驗、探討準父母生產期望與生產經驗之相關性及預測影響其生產經驗之因素。採縱貫性調查法，方便取樣於中部二所產科醫院，產前有效樣本為200對夫妻，產後為141對夫妻。統計方法包括描述性統計、因素分析、卡方、Mann-Whitney U test、t檢定、單因子變異數分析、皮爾森積差相關及逐步複迴歸分析。研究結果顯示：（一）生產期望方面：準父母皆最期望母嬰平安健康、產程順利且較短、醫護人員親切的對待或在撐不下去時有人鼓勵；準爸爸會因個人社經地位較高及接受過生產教育而有較高的生產期望，準媽媽則未因基本屬性不同而有差異；（二）準媽媽最正向的待產經驗為配偶的幫助，準爸爸為待產時與醫療人員合作，準父母最正向的分娩經驗皆為第一次抱著寶寶時之愉悅感。（三）準媽媽對醫療環境及醫護支持的期望比準爸爸高；準媽媽生產經驗較準爸爸差。（四）準媽媽與準爸爸整體生產期望與整體生產經驗呈正相關，即準父母生產期望愈高，生產經驗愈好。（五）準媽媽生產經驗的預測因子為：生產方式符合期望、醫生滿意、控制與參與期望、產痛預期、孕期情緒支持及產時情緒支持，六變項解釋總變異量的31%；準爸爸生產經驗的預測因子為：產次、產時情緒支持、麻醉方式、進產房陪產、產痛預期及醫護支持期望，六變項解釋總變異量的26%。本研究結果有助於臨床醫護人員瞭解準父母對生產過程的期望、經驗與及其影響因素，祈以改善醫療照護方式，並促進準父母擁有滿意的生產經驗。

The purpose of this research was to compare expectant parents expectations on childbirth and birth experiences; and therefore to explore the relationship between couple’s childbirth expectations and experiences, and impact factors that influenced birth experiences. The design of this research was a longitudinal survey. A sample of 200 couples in their third trimester was recruited from two obstetrical outpatient centers in middle region of Taiwan. The same subject was approached again at postpartum units. The total valid sample size for postpartum was 141 couples. The questionnaires consisted of descriptive statistics, factor analysis, χ2, t-test, one-way ANOVA, Pearson’s correlation, and stepwise multiple regression were used to analyze the data. The results were as follows: (1) First three expectations about expectant parents childbirth were safety and staying healthy, labor duration’s being short and normal, and be encouraged by nurse. (2) The first rank of positive feelings towards birth experience of expectant parents was touching baby (3) Expectant mother more expecting the birth environment and the supporting professional staff than expectant father. The expectant mothers less experience of birth then expectant father. (4) There is a correlation between couple’s expectations on childbirth and their birth experiences.(5) The six that contributed to explain mothers’ overall birth experiences were satisfying expectation for delivery, satisfied medical procedure, involvement and participation in the birth process, anxiety of labor pain, partner support of the pregnancy and partner support in labor. The six that contributed to explain fathers’ overall birth experiences were parity, partner support in labor, obstetric analgesia, birth attendance, anxiety of labor pain and support from professional.The result of this research would help obstetric nurses to provide appropriate nursing service for couples’ in labor, so as to elevate nursing care quality and help couples’to have positive and satisfying birth experiences.
Keywords: childbirth expectations. birth experience

目 錄 頁次
誌謝………………………………………………………………………………Ⅰ
中文摘要…………………………………………………………………………Ⅱ
英文摘要…………………………………………………………………………Ⅳ
目錄………………………………………………………………………………Ⅴ
圖表目錄…………………………………………………………………………Ⅶ
第一章 緒論
第一節 研究動機與重要性…………………………………………………. 1
第二節 研究目的…………………………………………………….……….3
第二章 文獻探討
第一節 生產夫妻於懷孕後期之心理變化…………………………………..4
第二節 準媽媽的生產期望…………………………………………………..6
第三節 準爸爸的生產期望………………………………………………….17
第四節 準媽媽的生產經驗………………………………………………….21
第五節 準爸爸的生產經驗………………………………………………….28
第六節 生產期望與生產經驗之相關性研究……………………………….32
第三章 研究方法
第一節 研究架構…………………………………………………………….34
第二節 研究假設…………………………………………………………….35
第三節 名詞界定…………………………………………………………….35
第四節 研究方法與研究對象……………………………………………….36
第五節 研究工具及其信度與效度……………………………….…………36
第六節 研究步驟………………………………………………………….…43
第七節 資料處理分析…………………………………………………….…44
第八節 研究倫理考量……………………………………………………….45
第四章 研究結果
第一節 研究對象之基本屬性…………………………………………….....46
第二節 準父母的生產期望………………………………………………….51
第三節 生產期望與基本屬性之差異…………..…………………………...57
第四節 準父母的生產經驗………………………………………………….58
第五節 基本屬性與生產經驗之比較……………………………………….62
第六節 生產期望與生產經驗之相關分析………………………………….67
第七節 影響生產經驗之預測因子…………………………….……………68
第五章 討論
第一節 研究對象之特性…………………………………..………………...75
第二節 準父母的生產期望……………………….…………………………78
第三節 準父母的生產經驗………………………………………………….81
第四節 生產期望與生產經驗的相關性…………………………………….83
第五節 影響準父母生產經驗之因素……………………………………….84
第六章 結論與建議
第一節 結論………………………………………………………………….86
第二節 建議………………………………………………………………….88
第三節 研究限制…………………………………………………………….90
參考文獻
中文部分………………………………………………………………………91
英文部分………………………………………………………………………94
附件一 研究工具………………………………………………………………101
附件二 研究工具使用同意書…………………………………………………118
附件三 專家名單………………………………………………………………120
附件四 研究對象參與同意書…………………………………………………121
圖 表 目 錄 頁次
圖3-1 夫妻生產期望與生產經驗的相關圖…………………………………….34
表3-1 社經地位等級之計算方式……………………………………………….37
表3-2 生產期望量表之因素負荷量每一因素之特徵直及解釋變異量……….40
表3-3 生產期望量表之Cronbach’s α值………………………………………41
表3-4 生產經驗態度量表之Cronbach’s α值…………………………………43
表3-5 研究對象來源…………………………………………………………….44
表4-1 研究對象之個人基本屬性……………………………………………….48
表4-2 研究對象之家庭屬性…………………………………………………….49
表4-3 準媽媽之產科學屬性…………………………………………………….50
表4-4 準媽媽生產期望量表得分及排序情形………………………………….52
表4-5 準媽媽生產期望各次量表之平均得分及排序情形…………………….53
表4-6 準爸爸生產期望量表得分情形………………………………………….54
表4-7 準爸爸生產期望各次量表之平均得分及排序情形…………………….55
表4-8準媽媽與準爸爸在生產期望單題平均分數之比較…………………………….56
表4-9基本屬性與生產期望之比較……………………………………………..58
表4-10準媽媽生產經驗態度量表之得分及排序情形…………………………59
表4-11準媽媽生產經驗態度分項量表之平均得分及排序情…………………60
表4-12 準爸爸生產經驗態度量表得分及排序情形…………………………...61
表4-13準爸爸生產經驗態度分項量表之平均得分及排序情形……………..62
表4-14 基本屬性與生產經驗之比較…………………………………………..64
表4-15 準媽媽與準爸爸在生產期望與生產經驗之比較……………………..65
表4-16 準媽媽與準爸爸在生產經驗單題平均分數之比較…………………...66
表4-17準媽媽與準爸爸生產期望與生產經驗之相關性(γ值)……………….68
表4-18影響準媽媽生產經驗的因素……………………………………………69
表4-19影響準媽媽待產經驗的因素……………………………………………70
表4-20影響準媽媽分娩經驗的因素……………………………………………71
表4-21影響準爸爸整體生產經驗的因素………………………………………72
表4-22影響準爸爸待產經驗的因素……………………………………………73
表4-23影響準爸爸生產經驗的因素……………………………………………7

中文部分
行政院衛生署(2001) ·中華民國90年衛生統計·台北：行政院衛生署。
李從業(2000) ·邁入千禧年以「家庭為中心」產科護理的回顧與展望·護理雜誌，47(3)，7-12。
李英倫、劉海婷、許美雲、紀玉秋、許美月、賴郁慧、林善(2001) ·某市立醫院爸爸參與陪產措施現況及影響因素分析·新台北護理期刊，3(2)，63-74。
林志忠(1994) ·佛洛母期望理論及其教育含意·中學教育學報，1，107-138。
林綺雲(1998) ·醫病關係人際互動理論的分析·諮商與輔導，149，8-12。
周汎澔、余玉眉、余德慧(1994) ·準父親初次陪伴待產及生產之經驗歷程·護理研究，2(4)，359-370。
周汎澔、余玉眉、余德慧(1995) ·準父親初次陪伴待產及生產之護理需求·護理研究，3(4)，376-386。
洪志秀、鍾信心、劉雅惠（1997）·夫妻對「丈夫參與分娩過程」之態度與其相關因素·高雄醫學科學雜誌，13(6)，360-369。
高美玲、陳昭惠、盧玉贏、潘呂嵐(2001) ·「嬰兒親善醫院」政策之介紹·護理雜誌，48(2)，59-61。
翁雪敏(1999) ·實施產前教育對分娩自我控制成效之探討·台北：國防醫學院護理研究所。
翁崇德（1998）·期望服務與服務績效影響服務品質評量之研究·台大管理論叢，9(1)，153-176。
莫藜藜、王行(1996) ·已婚男性的家庭價值觀及其對家庭需求的探討·東吳社會工作學報，2，57-114。
陳麗芳(2000) ·婦女生產期望與生產經驗之相關性探討·台北：國防醫學院護理研究所。
陳麗芳、李從業、張玉坤、夏萍絅、彭成煌(2001) ·婦女生產期望與生產經驗之相關性探討·護理雜誌，48(4)，61-71。
陳素賢(1998)·姿位護理方案對分娩婦女疼痛感受及自我效能之效果·高雄：高雄醫學院護理研究所碩士論文。
陳彰惠、余玉眉、黃光國(1984) ·構成妊娠第三期婦女心理壓力之因素·公共衛生，10(1)，88-98。
馮容莊、夏萍絅、張碧芬、馮琪瑩(1999) ·台灣北部地區孕產婦接受產前衛生教育之概況調查·榮總護理，16(2)，177-190。
馮容莊(1996) ·鬆弛技巧與產婦生產自我效能之相關性探討·榮總護理，13(3)，311-320。
張郁婉(1994) ·待產婦產痛情形之分析及探討·公共衛生，21(2)，128-141。
張韶敏、陳彰惠（2000）·分娩護理支持與產婦生產經驗之相關性探討·護理研究，8(6)，663-672。
曾雅玲、余玉眉(1994) ·正常分娩的初產婦於待產及生產時主觀經驗之探討·護理研究，2(4)，327-337。
曾雅玲、王麗玲、施幼玲(1993)·準爸爸於生產過程的行為反應及護理需求之初步探討·護理研究，1(3)，279-289。
傅雅麟、李從業、葉翠芬（2001）·婦女經歷先生陪伴生產之生活經驗·護理雜誌，48(4)，51-59。
劉仲冬(1998) ·女性醫療社會學·台北：女書。
蔡秀美、陳彰惠(1997) ·準父親的身體化症狀、壓力與社會支持·護理研究，5(5)，439-450。
鍾聿琳(1996) ·生產教育課程成效之探討·國立台北護理學院學報，4，1-24。
鍾聿琳(1999) ·醫院內家庭化之產婦照護·台灣醫學，3(5)，614-619。
鍾聿琳、吳佳容(2002)·水中生產－一種另類分娩方式·護理雜誌，49(1)，23-27。
謝臥龍(1992) ·由父親的角色對子女成長的影響來談婦幼與父幼之意義·婦女研究通訊，26(257)，9。
醫病關係與消費者權益(2000) ·全國律師，4(10)，12-17。
英文部分
Bartels, R. (1999). Literature review. Experience of childbirth from the father’s perspective. British Journal of Midwifery, 7(11), 681-683.
Beaton, J., & Guyton, A. (1990). Childbirth expectations：A qualitative analysis. Midwifery, 6(3), 133-139.
Berry, L. M. (1988). Realistic expectations of the labor coach. Journal of Obstetrics and Gynecologic and Neonatal Nursing, 17(5), 354-355.
Callister, L., ＆ Hobbins-Garbett, D. (2000). Cochrane pregnancy and childbirth database: Resource for evidence based practice. Journal of Obstetrics and Gynecologic and Neonatal Nursing, 29, 123-128.
Chandler, S., & Field, (1997). Becoming a father: first-time father’s experience of labor and delivery. Journal of Nurse-Midwifery, 42, 17-24.
Chapman, L. (2000). Expectant fathers and labor epidurals. The American Journal of Maternal /Child Nursing, 25(3), 133-138.
Chapman, L. (1992). Expectant fathers’ role during labor and birth. Journal of Obstetrics and Gynecologic and Neonatal Nursing, 21(2), 114-119.
Coffman, S., Levitt, M. J., & Brown, L. (1994). Effects of clarification of support expectations in prenatal couples. Nursing Research, 43(2), 111-116.
Drummond, J., & Rickwood, D. (1997). Childbirth confidence: validating the Childbirth Self-Efficacy Inventory(CBSCI) in an Australian sample. Journal of Advanced Nursing, 26(3), 613-622.
Evan, S., ＆ Jeffrey, J. (1995). Maternal learning needs during labor and delivery. Journal of Obstetric Gynecologic and Neonatal Nursing, 24(3), 235-240.
Fawcett, J., Pollio, N., & Tully, A. (1992). Women’s perceptions of cesarean and vaginal delivery: another look. Research in Nursing and Health, 15(6), 439-446.
Fawcett, J., & Knauth, D. (1996). The factor structure of the perception of birth scale. Nursing Research, 45(2), 83-86.
Green, J. M., Coupland, V. A., & Kitzinger, J. V. (1990). Expectations, experiences, and psychological outcomes of childbirth：A prospective study of 825 women. Birth, 17(1), 15-24.
Green, J. M. (1993). Expectation and experience of pain in labor: findings from a large prospective study. Birth, 20(2), 65-72.
Jordan, P. L. (1990). Laboring for relevance: Expectant and new fatherhood. Nursing Research, 39(1), 11-16.
Gupton, A., Beaton, J., Sloan, J., & Bramadat, I. (1991). The development of a scale to measure childbirth expectations. The Canadian Journal of Nursing Research, 23(2), 35-47.
Hallgren, A., Kihlgren, M., Forslin, L., & Norberg, A. (1999). Swedish fathers’ involvement in and experiences of childbirth preparation and childbirth. Midwifery, 15(1), 6-15.
Hallgren, A., Kihlgren, M., Norberg, A., & Forslin, L. (1995). Women’s perceptions of childbirth and childbirth education before and after education and birth. Midwifery, 11(3), 130-137.
Hodnett, E. (2001). Continuity of caregivers for care during pregnancy and childbirth. The cochrane library, 4(5), CD-ROM.
Hodnett, E. (1996). Nursing support of the laboring woman. Journal of Obstetrics and Gynecologic and Neonatal Nursing, 25(3), 257-264.
Hollinghead, A. B. (1975). Two factor index of social status. New Haven, CT : Department of Sociology, Yale University.
King, I. M. (1992). King’s theory of goal attainment. Nursing Science Quarterly, 5(1),19-26.
Kravitz, R. L. (2001). Measuring patient’ expectation and requests. Annals of Internal Medicine, 134(9(part2)), 881-888.
Lavender, T., Walkinshaw, S. T., & Walton, I. (1999). A prospective study of women’s view of factors contributing to a positive birth experience. Midwifery, 15(1), 47-57.
Liukkonen, A., & Vehvilainen-Julkunen K. (1997). Fathers'' childbirth experience and nursing interventions [Finnish]. Hoitotiede, 9(3), 118-26.
Lowe, N. k. (1992). Differences in first and second stage labor pain between nulliparous and multiparous women. Journal of Psychosomatic Obstetric and Gynecology, 13(3), 243-253.
Lowe, N. k. (1996). The pain and discomfort of labor and birth. Journal of Obstetric Gynecologic and Neonatal Nursing, 25(1), 82-89.
Lundgren, I., & Dahlberg, K. (1998). Women’s experience of pain during childbirth. Midwifery, 14(2), 105-110.
Mackey, M. C., & Lock, S. E. (1989). Women’s expectations of the labor and delivery nurse. Journal of Obstetrics and Gynecologic and Neonatal Nursing, 18, 505-512.
Mackey, M. C. (1990). Women’s preparation for the childbirth experience. Maternal-Child Nursing Journal, 19(1), 143-173.
Manogin, T. W., Bechtel, G. A., & Rami, J. S. (2000). Caring behaviors by nurses: women’s perception during childbirth. Journal of Obstetric Gynecologic and Neonatal Nursing, 29(2), 153-157.
McCrea, B. H., & Wright, M. E. (1999). Satisfaction in childbirth and perceptions of personal control in pain relief during labour . Journal of Advanced Nursing, 29(4),877-884.
Mercer, R. T., Hackley, K. C., & Bostrom, A. G. (1983). Relationship of psychosocial and perinatal variables to perception of childbirth. Nursing research, 32(4), 202-207.
Moore, M., & Hopper, U. (1995). Do birth plans empower women? Evaluation of a hospital birth plan. Birth, 22(1), 29-36.
Nichols, F. H., & Humenick, S. S. (2000). Childbirth education: practice, research and theory. Philadelphia: W. B. Saunders.
Nichols, F. H., & Zwelling, E. (1997). Maternal-Newborn Nursing: Theory and Practice. Philadelphia: W. B. Saunders.
Nichols, M. R.(1993). Paternal perspectives of the childbirth experience. Maternal-Child Nursing Journal, 21(3), 99-108.
Rubin, R. (1984). Maternal Identity and the Maternal Experience. New York : Springer Publishing Company.
Palkovitz, R. (1987). Fathers’ motives for birth attendance. Maternal-Child Nursing Journal, 16(2), 123-129.
Sandelowski, M. (1984). Expectations for childbirth versus actual experiences: the gap widens. Maternal-Child Nursing Journal, 9 , 237-239.
Somers-smith, M. J. (1999). A place for the partner？Expectations and experiences of support during childbirth. Midwifery, 15(2).101-108.
Stamler, L. (1998). The participants views of childbirth education : Is there congruency with an enablement framework for patient education？Journal of Advanced Nursing, 28(5), 939-947.
Stark, M. A. (1997). Psychosocial adjustment during pregnancy: the experience of mature gravidas. Journal of Obstetric Gynecologic and Neonatal Nursing, 26(2), 206-211.
Stolte, K. (1987). A comparison of women’s expectations of labor with the actual event. Birth, 14(2), 99-103.
Tarkka, M., & Paunonen, M. (1996). Social support and its impact on mother’s experience of childbirth. Journal of Advanced Nursing, 23(1), 70-75.
Tarkka, M., Paunonen, M., & Laippala, P. (1996). Importance of the midwife in the first-time mother’s experience of childbirth. Scandinavian Journal of Caring Science, 14(3), 184-190.
Vehvilainen-Julkumen, K., & Liukkonen, A. (1997). Fathers’ experiences of childbirth. Midwifery, 14(1), 10-17.
Liukkonen, A., & Vehvilainen-Julkumen, K. (1997). Fathers’ childbirth experiences and nursing intervention（finnish）. Hoitotiede, 9(3), 118-126.
Waldenstrom, U., Brog, I., Olsson, B., Skold, M., & Wall, S. (1996). The childbirth experience: a study of 295 new mothers. Birth, 23(3), 144-153.
Wan, Y. I. (2000). Relationships between partners support during labor and maternal outcomes. Journal of Clinical Nursing, 9(2), 265-272.
Whitford, H. M., & Hillan, E. M. (1998). Women’s perceptions of birth plan. Midwifery, 14(2), 248-253.