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1 J. Jpn. Acad. Midwif., Vol. 23, No. 2, , 2009 原 著 助産師による退院後の母乳育児ケアにおける観察視点 Observation viewpoints by midwives on breastfeeding after discharges Chieko OSADA 抄 録 目的 対象と方法 6 25 結果 3 結論 3 キーワード : St. Luke's College of Nursing
2 Abstract Purpose The present study aims to make a sampling of the factors constituting the observation viewpoints by midwives in the community who are well versed in breastfeeding during lactation period, and thus to clarify the characteristics of their viewpoints. Methods The study was carried out at a midwife clinic specializing in breastfeeding support, a hospital and a maternity center in Japan. The subjects for this study were 6 midwives, and 25 postnatal women who received the breastfeeding care by the midwives for the first time were employed as the study collaborators. We conducted the semistructured interviews with the subjects after making observations at breastfeeding care for the study collaborators, and made a sampling from the data collected that were deemed to be the "observations by midwives". Then we compared our categorized data with those in the literature. Results The observation factors for assessing breastfeeding care by midwives for the postnatal women and the children were composed of the 3 categories, i.e. "Mother", "Child" and "Mother and Child". In comparison with the previous studies, the category of "Mother" was found to additionally contain the sub-categories of "Behavior Characteristics", "Reflection" and "Image" as the indicators of psychological state, and the sub-categories of "Clothes", "Lifestyle" and "Medical support" as the indicators of social state. The sub-category of "Behavior characteristics" indicated the women's behavior based on their cultural values. The "Child category" was newly sub-divided into "Power" and "Follow-up". Also in the category of "Mother and Child", the sub-category of "Event" was newly added in the present study. As the observation characteristics by midwives, the observation factors attaching great importance to specific and individualized aspects of the environment or life surrounding a mother and child were taken as a sample. Among such observation factors, especially the observation factor of midwives evaluating the conditions of breasts by touching them using their own hands was taken as a sample. Furthermore, as the characteristics of the observation viewpoints by midwives, these were constructed on not only the respective viewpoints of "Mother" and "Child", but also the viewpoint of the dyad of "Mother and Child". Conclusion It was found that, in breastfeeding care, midwives observed multi-facedly the detailed information closely related to the life of a mother and child during the lactation period, examining directly the breast conditions by their own hands. Moreover, their observations characteristically consisted of not only the respective viewpoints of "Mother" and "Child", but also the viewpoint of the dyad of "Mother and Child". Keywords: breastfeeding care, midwife, observation, lactation period, after discharge Ⅰ. 緒言 UNICEFWHO B-R-E-A-S-T FEED J. Jpn. Acad. Midwif., Vol. 23, No. 2,
3 OBSERVATIONUNICEF/WHO 1993/2003 SAIBSystematic Assessment of the Infant at BreastShrago, 1990LATCHBreastfeeding Assessment ToolRiordan, Riordan, Ⅱ. 研究目的 Ⅲ. 用語の操作的定義 Ⅳ. 研究方法 1. 研究対象 ( 助産師 ) と協力者 ( 母子 ) データ収集期間 データ収集方法 PubMed Marmet & Shell, 1984; Mulford, 1992; Jensen et al, 1994; Adams, 1997; Matthews,
4 4. データ分析と分析の信頼性と妥当性の確保 倫理的配慮 Ⅴ. 結果 1. 対象者の背景 International Board Certified Lactation Consultant 1Baby Friendly Hospital 表 1 対象助産師の概要助産師歴助産師 ( 年 ) A B C D E F 母乳育児ケア専門歴 ( 年 ) 母乳育児ケア時間 ( 時間 / 1 週間 ) IBCLCInternational Board Certified Lactation Consultant 2 BFHBaby Friendly Hospital 3 勤務形態 母乳育児ケアの基礎的教育機関 IBCLC 1 BFH 2 BFH BFH 3 J. Jpn. Acad. Midwif., Vol. 23, No. 2,
5 表 2 助産診断の違いによる受診日と受診者数 対象症例 ( 母乳育児ケアの受け手である母子 ) の概要 母乳育児ケアにおける助産師の観察視点 表 3 平最最 助産診断の違いによる受診日 均短長 分泌不安 (N=12) 乳房トラブル (N=13)
6 表 4-1 母乳育児ケアにける観察視点 ( インタビュー ) と 母乳育児ケアの観察項目 ( 既存研究 ) の比較 身体的状態 妊娠 産褥期の経過 母乳育児ケアにける観察視点 ( インタビュー ) 母乳育児ケアの観察項目 ( 既存研究 ) 項目因子因子 乳房の状態 特 体 性 調 妊娠期 分娩期 産褥早期 退院 受診 乳腺体 乳 輪 乳 頚 乳 頭 乳 管 排 乳 口 乳 分 搾 汁 泌 乳 J. Jpn. Acad. Midwif., Vol. 23, No. 2,
7 心理的状態社会 文化的状態 生 活 環 境 支 援 トラブル 自己管理 行動特性 内 省 イメージ 食生活 住 居 衣 服 生 活 経 済 育児経験 家 周 知 族 囲 識 医療者
8 J. Jpn. Acad. Midwif., Vol. 23, No. 2,
9 表 4-2 母乳育児ケアのアセスメント指標( インタビュー ) と 母乳育児ケアの観察項目( 既存研究 ) の比較 子ども 母乳育児ケアにける観察視点( インタビュー ) 母乳育児ケアの観察項目( 既存研究 ) 項目因子因子 身体的状態 医療との関わり 身 体 パワー 1 栄養離乳食 入院中 フォローアップ NICU NICU 助産師による退院後の母乳育児ケアにおける観察視点の概念図
10 表 4-3 母乳育児ケアのアセスメント指標 ( インタビュー ) と 母乳育児ケアの観察項目 ( 既存研究 ) の比較 母子 時期 出来事 授 乳 母乳育児ケアにける観察視点 ( インタビュー ) 母乳育児ケアの観察項目 ( 既存研究 ) 項目因子因子 時期 イベント 授乳状態 姿 吸 吸 勢 着 啜 授乳後の変化 補助具 補足状況 母親 母子 子 図 1 助産師による退院後の母乳育児ケアにおける観察視点の概念図 J. Jpn. Acad. Midwif., Vol. 23, No. 2,
11 1 Ⅵ. 考察 1. 助産師が行っている観察の特徴 Benner. P, et al1999/ 観察項目( 既存研究 ) と 母乳育児ケアにける観察視点 ( インタビュー ) の比較
12 観察視点の構成因子について Ⅶ. 結論 3 Ⅷ. 研究の限界と今後の課題 6 謝辞 2006 J. Jpn. Acad. Midwif., Vol. 23, No. 2,
13 文献 Adams, D., Hewell, S. (1997): Maternal and professional assessment of breastfeeding, 13(4), (3) Benner, P., Hooper, K., Patricia, S., et al. (1999) (3) (5) (11) Jensen, D., Wallance, S., Kelsay, P. (1994). LATCH: A Breastfeeding Charting System and Documentation tool. Journal of Obstetric Gymecologic and Neonatal Nursing, 23, (1) (9) [ ] (1) Marmet, C. & Shell, E. (1984). Training neonates to suck correctly. MCN: American Journal of maternal Child Nursing, 9, Matthews, M.K. (1988). Developing an instrument to assess infant breastfeeding behaviour in the early neonatal period. Midwifery, 4, (3) Mulford, C. (1992). The Mother-Baby Assessment (MBA): An "Apgar Score" for breastfeeding, Journal of Human Lactation, 8(2), (2) (4) (3) Riordan, J.M. & Koehn, M. (1997). Reliability and validity testing of three breastfeeding assessment tools, J Obstet Gynecol Neonatal Nurs, 26(2), Shrago, L. & Bocar, D. (1990). The infant's contribution to breastfeeding, J Obstet Gynecol Neonatal Nurs, 19(3), (2) (7) (5) (8)
14 BREAST Feed Observation 19(3) UNICEF/WHO (1993) 2003UNICEF/ WHO J. Jpn. Acad. Midwif., Vol. 23, No. 2,
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