本研究目的在探討剖腹生產指導方案，對婦女之焦慮、24小時親子同室率、純母乳哺餵率及手術後72小時內第一次進食、活動之成效。本研究以類實驗設計，研究對象為北區某教學醫院妊娠滿36週以上醫療因素預備剖腹生產之100位婦女，實驗組與對照組各50位。收案時研究對象完成個人基本資料、特質情境焦慮量表，入院剖腹產的之前及產後24內各再填寫一次情境焦慮量表。研究結果實驗組產婦在住院日手術前焦慮分數得分明顯低於對照組 (37.96 vs. 44.78, t = -3.43, p < 0.001），手術後則兩組無顯著差異。實驗組產婦在手術後24小時親子同室率(80% vs. 24%, χ2 = 31.41, p < 0.001)與純母乳哺餵(74.0% vs. 38.0%, χ2 =13.15, p < 0.001)皆高於對照組。手術後72小時內不論是在手術後第一次開始喝水(438 vs. 2006, t = 13.73, p < 0.001)、進食(633 vs. 2528, t = 16.86, p < .001)或是活動 (坐起、下床、照顧新生兒)( 896 vs. 1459, t = 4.49、1431 vs. 2102, t = 6.02, 1916 vs. 3575, t = 6.80，p < .001）的時間都比對照組早。剖腹產生產指導方案可以減輕手術前焦慮提升純母乳餵率、24小時親子同室率及促進生理功能恢復，可提供健康照護人員實證的措施。
關鍵字：剖腹生產、焦慮、母乳哺餵、早期進食、下床

The objective of this study was to evaluate how a cesarean preparing education program for pregnant women affected their anxiety, first time oral feeding and activities after cesarean , exclusive breastfeeding and 24-hour rooming-in rate after birth within hospital. The quasi-experimental design was used. The targeted population was primigravidas at 36 weeks and who had chosen to deliver by caesarean section with medical indication. A total of 100 pregnant women who met the study criteria, were allocated to experimental (n = 50) and control (n = 50) groups. The study was conducted at a regional teaching hospital in Taipei, Taiwan. The pregnant women completed their basic personal information and a State-Trait Anxiety Inventory when they were recruited. All the participants completed a State of Anxiety Inventory when they were admitted before the cesarean operation day and 24-hour after birth. The women in the experimental group had a lower state anxiety (37.96 vs. 44.78, t = -3.42, p < .001) before the cesarean section, and no significant difference after birth; a higher 24 hours rooming-in rate (80% vs. 24%,χ2 = 31.41, p < .001), and a higher exclusive breastfeeding rate (74.0% vs. 38.0%, χ2 =13.15, p < 0.001) ; an earlier oral fluid (438 vs. 2006, t = 13.73, p < .001), oral food (633 vs. 2528, t = 16.86, p < .001), sitting up (896 vs. 1459, t = 4.49, p < .001), out of bed (1431 vs. 2102, t = 6.02, p < .001), and taking care of newborn (1916 vs. 3575, t = 6.80，p < .001). The results justify the clinical implementation of “cesarean preparing education program” as an effective means of reducing anxiety and improving physical recovery amongst expectant mothers. This cesarean preparing education program has proven to be successful in providing health care professionals with an evidence-based intervention.

Keywords: cesarean birth, anxiety, breastfeeding, early oral food, out of bed

目 錄
致謝………………………………………………………………………………I
中文摘要…………………………………………………………………………II
英文摘要…………………………………………………………………………III
第一章 緒論
第一節 研究動機及背景……………………………………………………1
第二節 問題陳述……………………………………………………………4
第三節 研究目的……………………………………………………………5
第四節 研究假設……………………………………………………………5
第五節 研究的重要性………………………………………………………6
第二章 文獻查證
第一節 剖腹生產手術……………………………………………………..8
第二節 剖腹產麻醉與術後止痛………………………………………… 11
第三節 剖腹生產手術的焦慮…………………………………………….14
第四節 剖腹產前準備對生產經驗的影響……………………………… 18
第五節 剖腹產手術前護理指導…………………………………………. 21
第六節 剖腹生產後的早期照護………………………………………….26
第七節 剖腹產手術後對早期母乳哺餵的影響………………………….34
第三章 研究方法
第一節 研究概念架構………………………………………………………40
第二節 研究設計……………………………………………………………42
第三節 研究對象與樣本數估計……………………………………………43
第四節 研究場所……………………………………………………………43
第五節 研究變項與操作定義………………………………………………44
第六節 介入措施…………………………………………………………..46
第七節 研究工具與信效度…………………………………………………48
第八節 資料收集……………………………………………………………50
第九節 資料分析方法………………………………………………………54
第十節 研究倫理考量………………………………………………………56
第四章 研究結果
第一節 研究個案之基本屬性……………………………………………….57
第二節 剖腹生產指導方案對產婦焦慮減輕之成效……………………… 62
第三節 實驗組與對照組24小時親子同室達成率及純母乳哺餵率之比較65
第四節 實驗組與對照組產婦術後開始進食時間之比較………………….66
第五節 實驗組與對照組產婦術後開始活動時間之比較…………………. 67
第六節 母乳哺餵率與親子同室相關之分析…………………………….… 69


第五章 討論
第一節 研究樣本基本屬性………………………………………………… 70
第二節 剖腹生產準備方案對不同情境下焦慮分數之影響比較………… 72
第三節 剖腹生產準備方案對母乳哺餵率及親子同室達成率之成效…… 74
第四節 剖腹生產準備方案對兩組產婦在手術後72小時內第一次開始進
食、下床活動時間之比較………………………………………… 77
第六章 結論與建議
第一節結論……………………………………………………………………80
第二節護理應用與建議………………………………………………………81
第三節研究限制與建議………………………………………………………83
參考文獻
中文參考文獻………………………………………………………………..85
英文參考文獻…………………………………………………………………89

附錄
附錄一 基本資料…………………………………………………………………102
情境焦慮量表(1)……………………………………………………….103
焦慮特質量表……………………………………………………………104
附錄二 情境焦慮量表(2)……………………………………………………… 105
附錄三 情境焦慮量表(3)……………………………………………………… 106
附錄四 術後72小時評值表…………………………………………………….107
附錄五 專家效度名單…………………………………………………………. 108
附錄六 剖腹生產準備手冊專家效度…………………………………………..109
附錄七 剖腹生產準備手冊專家建議的整體建議………………………………110
附錄八 剖腹產麻醉方式之比較整理 ………………………………………….112
附錄九 剖腹生產率………………………………………………………………113
附錄十 研究工具使用同意書……………………………………………………116
附錄十一人體研究計畫核准書………………………………………………… 117

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