臺灣博碩士論文加值系統

受訪者中有94位採行了減痛分娩的措施，約佔受訪總人數之72.3%；產後婦女獲得減痛分娩的資訊來源主要以親朋好友(97人)最多。產婦對於減痛分娩認知得分則以「使用減痛分娩麻醉藥是不是會讓寶寶出生後嗜睡」最高，而以「施打減痛分娩是不是會造成產後背痛」得分最低；而產婦減痛分娩態度方面：顯示受訪者對減痛分娩行為利益態度與行為障礙屬正向程度；產婦的職業、減痛分娩經驗、待產時疼痛程度在減痛分娩認知具有統計上顯著差異；產婦的職業、減痛分娩經驗在減痛分娩態度知具有統計上顯著差異。減痛分娩態度對影響產婦施打減痛分娩行為具有預測力。
產婦使用減痛分娩可透過醫師、護理人員及其他宣導管道，加強宣傳減痛分娩的知識及好處，以減少家人的反對，醫療機構應提升醫療服務品質，以建立口碑行銷。政府部門可制定政策鼓勵減痛分娩，不但可減輕產婦生產時的疼痛感，且可增加生育率，降低剖腹生產率。

The pain of natural childbirth is one of the strictest pains among women. pregnant women who use epidural analgesia to deliver their babies will be able to relieve their pressure, fear and pain. This study aims to explore cognition, attitude and related factors of epidural labor analgesia among awaiting delivery.
This study used a cross-sectional survey to vaginal delivery women who are willing to accept a structured questionnaire for the survey. A total of 150 questionnaires were collected, 130 valid samples and a response rate of 86.67 %. For data analysis, the study uses SPSS 18.0 for Window and conduct descriptive statistics and inferential statistical analysis.
The results of this study showed that 94 respondents out of 130 adopted epidural labor analgesia, which was accounted for 72.3%. postnatal women who mainly obtained information sources of epidural labor analgesia came from their relatives and friends. The highest score of epidural labor analgesic cognition was "Is it easy to sleep for your baby after you give a birth using epidural labor by analgesia”, while the lowest score of that was “Is it possible for your back pain after you using epidural labor analgesia”. The two dimensions of epidural labor analgesic attitude show position level. The participants’ occupations, experience of epidural labor analgesia, and pain during awaiting delivery have statistical significant difference for epidural labor analgesic cognition. The participants’ occupations, experience of epidural labor analgesia have statistical significant difference for epidural labor analgesic attitude. Epidural labor analgesic attitude has influence to women who use epidural labor analgesia.
Medical staffs should promote the benefits and knowledge of epidural labor analgesia in order to reduce the family's objections. Meanwhile, hospital authorities have to improve their quality of medical services, and establish their reputation. Government has to develop policies about epidural labor analgesia for awaiting delivery, which not only relieve pain when maternal labor, but also increase fertility rate, and reduce cesarean delivery.

目錄
中文摘要 I
Abstract II
目錄 ………………………………………………………………… IV
圖目錄 ………………………………………………………………… VI
表目錄 ………………………………………………………………… VII
本文
第壹章 前言
第一節 研究背景及動機 …………………………………… 01
第二節 研究目的 .…………………………………… 04
第三節 研究問題 …………………………………… 05
第四節 研究重要性 …………………………………… 06
第貳章 文獻回顧
第一節 產痛與分娩過程 …………………………………… 07
第二節 臨床待產其他減痛分娩改善疼痛方式 …………… 16
第三節 產婦採用減痛分娩之實證研究 …………… 21
第四節 減痛分娩的影響 …………………………………… 27
第五節 知識、態度與行為模式應用 …………… 30
第参章 研究方法
第一節 研究架構………………………………………33
第二節 研究假設………………………………………34
第三節 研究流程………………………………………37
第四節 研究對象………………………………………38
第五節 研究工具………………………………………38
第六節 資料整理與統計分析………………………50
第七節 研究倫理………………………………………52
第肆章 研究結果
第一節 描述性統計分析…………………………53
第二節 推論性統計分析…………………………61
第伍章 結論與建議
第一節 結論………………………………………72
第二節 建議…………………………………76
第三節 研究限制與未來研究的建議…………………………78
文獻參考
中文部份…………………………………………………80
英文部分……………………………………………82
附錄
附錄一 本研究正式量表………………………………87
附錄二 專家效度名單…………………………………90
附錄三 人體試驗委員會審核通過證明………………………91
附錄四受試者意願填寫書面同意書………………………92

丁彥伶（2013，5月9日）。生小孩像被砂石車輾過。蕃薯藤新聞。 取自http://history.n.yam.com/liontravel/healthy/20130509/20130509459511.html
于桂蘭等譯（1989）。產科護理學（下冊）。台北：文軒。
史麗珠、陶夙琪、林佳慧、羅良明、蔡榮財、郭璧如（2004）．國內產婦使用無痛分娩之初探．秀傳醫學雜誌，5（1-2），9-18。
生殖百科（未註明）。減痛分娩。奇美醫療財團法人。民102年10月20日，取自: http://labbaby.idv.tw/inspection-detail.php?k_id=110#.UmT6b_k0WuI。
石明煌、陳香菊、林長春（2005）。無痛分娩．慈濟醫學，17（6），57-61。
何權峰（1996）。穴道保健新紀元。台北：宏欣文化。
余玉眉（1991）。婦嬰護理學下冊。台北：華杏。
吳銅坤(1983)。實用產科學，台北：合記。
李尹暘、林曉佩、林君怡(2007)。自我效能理論之分析與應用。澄清醫護管理雜誌，3(2)，46-51。
李麗珠、郭碧照（1998）。初產婦待產期間產痛分析及減輕產痛護理措施之探討。中山醫學雜誌，9（1），65-74。
李詠瑞、馬素華、史麗珠、楊靖孙(2002) 。音樂處置對癌症疼痛之成效。台灣醫學，6(5)，682-690。
邱皓政 (2003)。自我概念向度與成份雙維理論之效度檢驗與相關因素研究。教育與心理研究，26(1)，85-131。
周雨樺、蕭伃伶、何美華、孫瑞瓊、林淑玲、黃樹欽合著，余玉眉教授總校(2007)。產科護理學。新文京開發出版股份有限公司。
林姿伊（1999）。採行無痛分娩術初產婦生產經驗之探討。發表的碩士論文，台北：國立陽明大學護理學研究所。
林碧莉 (2001) 花蓮地區慢性阻塞性肺疾病患對肺部復建的知識;態度;行為及相關因素探討。美和學報，19期。
洪志秀、鍾信心、劉雅惠（1997）。夫妻對「丈夫參與分娩過程」之態度與及相關因素。高雄醫學科學雜誌，13（6），360－369。
洪泰和(2013)。婦產科醫師寫給準媽媽！懷孕生產一定要知道的大小事。台灣廣夏。
洪麗嬌、鍾聿琳（1996）‧談疼痛控制的理論及護理策略‧國立台北護理學院學報，4：25-30‧
郭素珍（2005）．婦女接受生產實務之評估及改進．行政院衛生署護理及健康照護處研究計畫，DOH94-HN-10．
洪漢陽編著(2006)。高危險新生兒的辨認與低體重兒的分類及罹患疾病。臨床新生兒科學(第四版，57頁)，台北；嘉洲。
徐明義（2012）。無痛分娩，YES or NO？。嬰兒與母親，第423期。民102年10月20日，取自http://mag.chinatimes.com/mag-cnt.aspx?artid=12088
張光宜(2006)。以「多屬性效用」模式探討減痛分娩的影響因素。國立台灣大學公共衛生學院預防醫學研究所，碩士論文。
張郁婉（1994）。待產婦疼痛情形之分析及探討。公共衛生，12（1），128-141。
張素娟（2005）。直立姿勢用立法對第二產程之效益。發表的碩士論文，台北：國立台北護理學院護理助產研究所。
張韶敏、陳章惠（2000）‧分娩護理支持與產婦生產經驗之相關性探討‧66護理研究，8(6)，663-671。
張淑貞、陳彰惠（2004）。音樂治療與母育護理之應用。護理雜誌，. 51（5），61-66。
張靜宜、余幕賢、陳俊忠、高美玲（2008）‧待產期視訊化生產球運動教學光碟的研發與初步評量。醫護科技學刊‧10（2）99-110。
張靜宜、高美玲（2006）。運用生產球協助婦女待產之經驗。護理雜誌，53（3）98-103。
張春興(1986)，心理學。台北市：東華出版社。
章新瑞. (1994)。環境試驗和可靠性試驗的類型及其設計技術。
教育部數位教學資源(民102)。新手媽媽。媽媽篇。民102年10月20日，取自:http://content.edu.tw/vocation/child_care/ks_sd/newmother/dir1441.htm。
陳再晉 (1983)。人類的分娩．台北:合記。
陳麗芳（2000）。婦女生產期望與生產經驗之相關性探討．發表的碩士論文，台北：國防醫學院護理研究所。
陳彰惠、張美月(2000)‧撫觸療法在分娩護理上的應用。護理雜誌，47(3)，28-32。
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‧未發表的碩士論文，高雄：高雄醫學院。
陳長安（2009）．常用藥物治療手冊．台北，全國藥品年鑑雜誌社。
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。
馮容莊（1996）‧鬆弛技巧與產婦生產自我效能之相關性研究‧榮總護理，13（3），311-320。
黃俊元、陳維昭、楊銘欽，(1995)。產婦特性與採用剖腹產：以台大醫院為例。中華公共衛生雜誌，16：309-318。
師慧娟、李從業、陳惟華，(2004)。視訊化拉梅茲生產法對產婦疼痛控制之評估。新台北護理期刊，6(1)，79-90。
趙有業、關俊、謝華(1995)。孕婦心理需求及分娩過程的心態調查。中國婦幼保健，5(1)，30。
葉宏軒、詹廖明義、劉素瑛、廖仁 (2002)。醫院女性員工對無痛分娩之了解與認知的調查。臺灣醫界 ，45(5)，36-39。
劉秀芬（2010）。疼痛治療與麻醉諮詢。第5~9 章，北京市：人民軍醫。
駱慧雯（2013）。麻醉害生產無力？減痛分娩4迷思。華人健康網，Yahoo新聞網。民102年10月20日，取自: http://www.top1health.com/Article/13124。
Ajzen, I. (1985). From Intentions to Actions: A Theory of Planned Behavior. In Kuhl, J., and Beckmann , J., Action Control: From Cognition to Behavior. Berlin Heidelberg Springer-Verlag, 11-39.
Adachi, K., Shimada, M., & Usui, A. (2003). The relationship between the parturient’s positions and perceptions of labor pain intensity. Nursing Research,52(1), 47-51.
Allport, G. W. (1935). Attitudes.
Bennett, VR. & Brown, LK. (1999).Myles Textbook for Midwives. Philadelphia: Churchill Livingstone.
Bromage, Philip Raikes. Epidural analgesia. Vol. 197. Philadelphia: Saunders, 1978.
Blackburn, S., & Loper, D. (1992). Chapter 2: The Prenatal Period and Placental Physiology. In Maternal, fetal, and neonatal physiology: A clinical perspective. W.B. Saunders, Philadelphia PA.Text in current use for medical and midwifery students.
Bonica ,J.J, McDonald, J.S.(1990). The pain of childbirth. In: J..J,Bonica,( 2nd ed.)The management of pain volume II.)Philadelphia: Lea & Febiger,1313-1343.
Bonica JJ, Chadw ick HS. (1996). Labour Pain. In:Wall PD, Melzack. eds.Testbook of pain, 2nd ed. New York: Churchill Livingstone, 482-499.
Boston Women’s Health Book Collective. (1992). The (New) Our Bodies, Ourselves. New York: Simon & Schuster.
Buckley, L. L., & Wright, K. (2010). Epidural analgesia in labor and childbirth . CINAHL Information Systems. Retrieved August 17, 2010, from http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=5&hid=105&sid=f5320e17-77d1-44f7-8ef1-7c89c05eb54a%40sessionmgr112
Chapman, L. L.（1992）. Expectant fathers’ roles during labor and birth. Journal of Obstetric Gynecologic and Neonatal nursing,21（2）,114-120.
Cook, A.& Wileox, G. (1997). Pressuring pain : Alternative therapies for labor pain management. Awhonn Lifeline,1(2), 36-141.
Crowe, K. & von Baeyer, C.（1989）. Predictors of a positive Childbirth experience. Birth,16（2）,59-63.
Chaffee, S. H., & Roser, C. (1986). Involvement and the consistency of knowledge, attitudes, and behaviors. Communication research, 13(3), 373-399.
Dickson, Silverman & Kaplan (1998). Labor, Birth & Recovery. In 69 Maternal-Infant Nursing Care (pp.278-306). St. Louis: Mosby
Farabow WS, Robeson VO, Maxey J, Spray BJ.(1993). A twenty-year retrospective analysis of the efficacy of epidural analgesia-anesthesia when administered and/or managed by obstetricians. Am J obstet Gynecol,169(2):207-7。
F. Cunningham, Kenneth Leveno, Steven Bloom, John Hauth, Dwight Rouse, Catherine Spong(2009), Williams Obstetrics: 23rd Edition.
Fenwick, J., Gamble, J., Nathan, E., Bayes, S., & Hauck, Y.(2009). Pre- and postpartum levels of childbirth fear and the relationship to birth outcome in a cohort of Australian women. Journal of Clinical Nursing, 18(5), 667－677. doi:10.1111/j.1365-2702.2008.02568.x
Fisher C, Hauck Y, Fenwick J.(2006). How social context impacts on women's fears of childbirth: a Western Australian example. Soc Sci Med: 63(1); 64-75.
Field, T., Hernandez-Reif, M., Taylor, S., Quintino, O., & Burman, I. (1997). Labor pain is reduced by massage therapy. Journal of Psychosomatic Obstetrics and Gynaecology, 18(4), 286-291.
Francine H.Nichols and Elaine Zwelling(1997).Maternal-Newborn Nursing Theory and Practice,22-24,701-861
Glanz, K., Rimer, B. K., & Lewis, F. M. (2002). Models of individual health behavior. In Glanz, K., Rimer, B. K., & Lewis, F. M., Health behavior and health education (3rd ed., pp. 41- 44). CA: Jossey-Bass.
Gaston-Johansson, F. Fridh, G. & Kopare, T. N. (1988). Progression of labor pain in primipars and multiparas. Nursing Research ,37(2),86-90.
Halpern SH, Leighton BL, Ohlsson A, Barrett JF, Rice A.( 1998) Effect of epidural vs parenteral opioid analgesia on the progress of labor: a meta-analysis. JAMA, 280:2105-10.
Harper, B. (2006). Gentle birth (Y. C. Tsai, Trans.). Taipei City, Taiwan, ROC: Third Nature. (Original work published 1994)
Hiltunen, P., Raudaskoski, T., Ebeling, H., & Moilanen, I. (2004). Does pain relief uring delivery decrease the risk of postnatal depression? Acta Obstetricia et Gynecologica Scandinavica, 83(3), 257-261.
Hodnett,E.(1996). Nursing support of the laboring woman. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 25(3),257-264.
Howell, CJ. (2002). Randomised study of long term outcome after epidural versus non-epidural analgesia during labour. BMJ ;325:357–9
Horne-Thompson, A., & Grocke, D. (2008).The effect of music therapy on anxiety in patients who are terminally ill. Journal of Palliative Medicine,11(4), 582-590.
Hardin, A. M., & Buckner, E. B. (2004). Characteristics of a positive experience for women who have unmedicated childbirth. The Journal of Perinatal Education, 13(4),10−16. doi:10.1624/105812404X6180
Hawkins J L, Arens J E, Bucklin B A, et al. Practice guidelines for obstetric anesthesia: A report by the American Society of Anesthesiologists task force on obstetrical anesthesia.Anesthesiology 1999; 90: 600–11.
Hofberg K, Ward MR (2003). Fear of pregnancy and childbirth. BJOG ,79:505–510.
Irvine LM (2001).Diagnosing suspected entopic pregnancy.Patients with falling concentrations of beta human chronic gonadotrophin should be seen regularly. British Medical Journal.322(7289):794.
Jackson NJ,Irvine LM (2000).The influence of maternal request on the elective.Jouranl of Obstetrics & Gynecology .18(2):115-119.
Janz, N. K., Champion, V. L., & Strecher, V. J. (2002). The health belief model. In Glanz, K., Rimer, B. K., & Lewis, F. M., Health behavior and health education (3rd ed., pp. 45- 66). CA: Jossey-Bass.
Kao, B. C., Gau, M. L., Wu, S. F., Kuo, B. J., & Lee, T. Y. (2004). A comparative study of expectant parents’ childbirth ex¬pectations . The Journal of Nursing Research, 12(3), 191－202.
Knapp RM, (1988). Epidural narcotics in obstetric anesthesia: Survey of SOAP members in 1987-88. Ann Metg, SOAP, P66.
Kamel, R. (2010). The onset of human parturition.Archives Of Gynecology And Obstetrics,281(6), 975-982.
Lederman, R. P., Lederman, E., Work, B. A., & McCann, D.S. (1985). Anxiety and epinephrine in multiparous women in labor: Relationship to duration of labor and fetal heart rate pattern. American Journal of Obstetrics and Gynecology, 153(8), 870–877.
Lowe, N. K. (1996). The pain and discomfort of labor and birth. Journal of Obstetric,Gynecologic, & Neonatal Nursing, 25(1), 82-92.
Lowe, N. K. (2002). The nature of labor pain. American Journal of Obstetrics and Gynecology, 186(5, Suppl.), S16－S24. doi:10.1016/S0002-9378(02)70179-8.
Merccer , R.T., Hackley ,K .C., & Bostrom ,A .G. (1983). Relationship of psychosocial perinatal variables to perception of childbirth. Nursing Research,32(4)202-207.
Melzack R, Kinch R, Dobkin P, Lebrun M, Taenzer P.(1984). Severity of labour pain: influence of physical as well as psychologic variables. Can Med Assoc J. 1;130(5):579-84
Melzack R, (1984).The myth of painless childbirth (The John J. Bonica Lecture). Pain,19:321.
McCaffery, M., & Pasero, C. (1999). Pain: Clinical Manual. Louis: Mosby.
Naseem Ali Sheikh, Khalid Bashir, Liaqat Ali, Shahida Khawaja. (2011).To study the safety and efficacy of epidural analgesia for labour. Pak J Med Health Sci ;5(1):71-5.
Nichols, M. R.（1993）. Paternal perspectives of the childbirth experience. Matern Child Nursing,21（3）,99-107.
Nichols,F.(1996).The meaning of the childbirth experience :A review of the literature .Journal of Perinatal Education,5(4).
Pasero, C. L.（1998）. Pain control. American Journal Nursing,98（8）,10-11.
Perez, P. G. (2002). Birth balls. Johnson, VT: Cutting Edge.
Pilot, D. F., & Hungler, B. P. (2004). Nursing research: principles and methods.
Poole, J. H. (2006). Analgesia and anesthesia during labor and birth: Implications for mother and fetus. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 32(6),780-793.
Raabe, N. &. Belfrage, P.,(2011).Epidural Analgesia in Labour : IV. Influence on Uterine Activity and Fetal Heart Rate.AOGS,305–310.
Rijnders, M., Baston, H., Schönbeck, Y., van der Pal, K., Prins,M., Green, J., & Buitendijk, S. (2008). Perinatal factors related to negative or positive recall of birth experience in women 3 years postpartum in the Netherlands. Birth,35(2), 107－116. doi:10.1111/j.1523-536X.2008.00223.x
Rothman, Barbara Katz. (1982). In Labor: Women and Power in the Birthplace. New York: Norton.
Rosenthal M B. (1994). Psychological aspects of obstetrics and gynecology In: Decherney AH & Pernoll ML. Current Obstetric & Gynecologic Diagnosis& Treatment. 8th ed. Norw alk: Appleton &Lange, 1901.
Reza, N., Ali, S. M., Saeed, K., Abul-Qasim, A., & Reza, T. H. (2007). The impact of music on postoperative pain and anxiety following cesarean section. Middle East Journal of Anesthesiology, 19(3), 573-586.
Resnik, D., & Rehm, M. (2001). The undertreatment of pain: scientific, clinical, cultural, and philosophical factors. Medicine, Health Care and Philosophy, 4(3), 277-288.
Stevensen, C. (1997). Shiatu. Complementary Therapies in Nursing & Midwifery, 3(6), 168-170.
Simkin, P. (1991). Just another day in a woman’s life ? Women’s long – term perceptions of their first birth experience , Part I, Birth ,18(4),203-210.
Sheiner ,E ,Levy, A , Feinstein ,U, Hallak,M & Mazor, M. (2002).Risk factors and outcome of progress during the first stages of labor: a populationbased study. Acta Obstetrica et Gynecologica Scandinavica, 81(3),222-226.
Simkin, P. (1991). Just another day in a woman’s life ? Women’s long – term perceptions of their first birth experience , Part I, Birth ,18(4),203-210.
Sears, D. O., Peplau, L. A., & Taylor, S. E. (1991). Social psychology 7 th ed.Social Cognition and Attitudes.
Thorp, JA. Hu DH, Albin RM, McNitt J, Meyer BA, Cohen GR. (1993).The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial. Am J Obstet Gyneco；169:851-8.
Thorp, JA. & Breedlove, G. (1996). Epidural analgesia in labor : An evaluation of risks and benefits. Birth, 23(2), 63-83.
Tzeng, Ya-Ling, Tsann-Juu Su, 2008. Low Back Pain during Labor and Related Factors. The Journal of Nursing Research,16-3.P231 - 241
Woodhouse, D. (1998). On-site seated acupressure massage. Positive health (32), 55-56.
Wallack, L. (1989). Mass communication and health promotion: A critical perspective. In R. E. Rice & C. E. Atkin (Eds.), Public communication campaigns (pp. 353–367). Newbury Park, CA: Sage.