유도분만 사전교육이 산모의 분만 경험, 상태 불안 및 분만 통증에 미치는 영향

Abstract

본 연구는 유도분만을 시행하는 산모에게 유도분만 사전교육을 제공하여 분만경험과 상태 불안 및 분만 통증에 미치는 효과를 확인하기 위해 시도되었다. 연구 대상자는 서울시 소재의 일개 종합병원에서 분만을 위해 입원한 산모 중 유도분만이 예정된 산모이며 실험군 30명, 대조군 30명 총 60명이다. 자료 수집은 2018년 1월부터 2018년 8월까지 구조화된 설문지를 이용하여 수집하였다. 실험 처치로 실험군에게는 입원 시 유도분만 사전교육 자료를 제공하며 유도분만 사전교육을 시행하였고, 대조군에게는 유도분만 과정이 포함되지 않은 기존의 입원 시 제공되는 분만실의 상례적인 교육을 제공하였다. 분만경험지각의 측정은 분만 후 2시간 이내에 실시하였다. 상태 불안의 사전조사는 입원 시 실험 처치가 이루어지기 이전에 실시하였으며, 사후조사는 자궁경부의 개대가 활동기(4-7cm)일 때 실시하였다. 분만통증은 자궁경부의 개대가 잠재기(2-3cm), 활동기(4-7cm), 이행기(8-10cm)일 때 측정하였다. 연구도구로 분만경험지각은 Marut & Mercer(1979)가 개발한 분만경험지각척도를 조미영(1988)이 번안하고 정향진(2004)이 수정한 도구를 사용하여 측정하였고, 상태 불안은 Spielderger(1972)의 불안척도를 김종택과 신동균(1978)이 번안한 도구를 사용하였으며, 분만통증은 VAS(Visual Analog Scale)을 이용하였다. 수집된 자료는 SPSS 25.0 프로그램을 이용하여 산출하였으며 대상자의 일반적 특성은 빈도분석 및 기술통계로 분석하고 실험군과 대조군의 동질성 검증은 x2-test와 Fisher’s exact test, independent t-test로 분석하였으며 분만경험지각의 차이는 independent t-test, 상태불안과 분만통증의 차이는 Mann-Whitney U test로 분석하였다. 본 연구의 결과는 다음과 같다. 1. 제1가설: ‘유도분만 사전교육을 받은 산모는 유도분만 사전교육을 받지 않은 산모보다 분만경험이 긍정적일 것이다.’의 검증결과 두 그룹 사이의 분만경험은 통계적으로 유의한 차이를 나타내지 않았다(t=-.584, p=.561) 2. 제2가설: ‘유도분만 사전교육을 받은 산모는 유도분만 사전교육을 받지 않은 산모보다 상태 불안정도가 낮을 것이다.’의 검증결과, 두 그룹 간의 상태 불안정도는 통계적으로 유의한 차이를 나타내지 않았다(z=-1.317, p=.188). 3. 제3가설: ‘유도분만 사전교육을 받은 산모는 유도분만 사전교육을 받지 않은 산모보다 분만 통증이 낮을 것이다.’의 검증결과 실험 처치 후 잠재기(z=-.343, p=.732), 활동기(z=-.417, p=.676), 이행기(z=-.506, p=.613) 모두 통계적으로 유의한 차이를 나타내지 않았다. 이상의 연구결과 유도분만을 시행하는 산모에게 본 연구에서 입원 시 제공한 유도분만 사전교육은 산모의 긍정적인 분만경험 및 상태 불안과 분만 통증 완화에 효과가 없는 것으로 나타났다. 이는 사전교육의 방법과 횟수가 선행연구들과 차이가 있기 때문이라고 사료되며 유도분만 산모의 긍정적인 분만경험 및 상태 불안과 분만 통증을 완화하기 위해서 유도분만 산모를 위한 교육의 적절한 방법과 내용을 고려해야 할 필요성이 있다. ;The purpose of this study was to investigate the effects of prior education on induction of labor to mothers on their childbirth experience, state anxiety, labor pain. The study was designed as a quasi-experimental study in the non-equivalent control group no-synchronized design. The subjects include mothers that were hospitalized for induction of labor at a general hospital in Seoul from January to August, 2018. Waiting for induction of labor, they were divided into the experiment group of 30 and control group of 30, as well. As for experimental treatments, the experiment group received the usual education for the delivery room, materials of prior education on induction of labor, and prior education of ten minutes or less on induction of labor. The control group received the usual education for the delivery room that did not cover the induction process of labor. Childbirth experience was measured within two hours from delivery. A pre- and post-test on state anxiety took place before the experimental treatments during hospitalization and at the active phase(4-7cm) of cervical dilatation, respectively. Labor pain was measured at the latent(2-3cm), active(4-7cm) and transitional phase(8-10cm) of cervical dilatation. Labor pain was measured with the VAS(Visual Analog Scale), and state anxiety and childbirth experience were measured with a structured questionnaire. The Perception of Birth Experience Scale developed by Marut & Mercer(1979), translated by Jo Mi-yeong(1988), and revised by Jeong Hyang-jin(2004) was used to measure childbirth experience. The State-Trait Anxiety Inventory developed by Spielderger(1972) and translated by Kim Jong-taek and Shin Dong-gyun(1978) was employed to measure anxiety. Collected data was treated with the SPSS 25.0 program for such general characteristics of subjects as actual number, percentage, mean and standard deviation. Homogeneity between the experiment and control group was tested and analyzed with X2-test, Fisher’s exact test and independent t-test which was also conducted to examine effects on childbirth experience. state anxiety and labor pain in both experiment and control group were analyzed with Mann-Whitney U test. The findings were as follows: 1. The study tested Hypothesis 1 “Mothers that receive prior education on induction of labor will have more positive childbirth experiences than mothers that receive no prior education on it” and found that there were no statistically significant differences in them between the groups(t=-.584, p=.561). 2. The study tested Hypothesis 2 “Mothers that receive prior education on induction of labor will have lower state anxiety than mothers that receive no prior education on it” and found that there were no statistically significant differences in it between the groups(z=-1.317, p=.188). 3. The study tested Hypothesis 3 “Mothers that receive prior education on induction of labor will experience less labor pain than mothers that receive no prior education on it” and found that there were no statistically significant differences in it between the groups at the latent(z=-.343, p=.732), active(z=-.417, p=.676), and transitional phase(z=-.506, p=.613) after the experimental treatments. These findings indicate that prior education on induction of labor provided to mothers scheduled to have it in the present study had no effects on their childbirth experience perception, state anxiety and labor pain. These findings indicate that it is difficult to relieve labor pain and state anxiety with education simply providing information with no interactions and that education of mothers’ first-hand experiences and interactions is effective for their labor pain and state anxiety. There are differences in the factors influencing childbirth experiences between mothers of induced labor and those of natural birth, which raises a need for educational content covering them. There are, however, limitations with the inclusion of a program both for pain relief training and childbirth experiences into the education of mothers expecting induced labor. As an alternative, continuous supports from nurses and spouses will be effective for their state anxiety and labor pain. When there is effective education for mothers expecting induced labor by supplementing prior education for induced labor in content and varying the timing and methods of education, active nursing interventions will be possible to promote their positive childbirth experiences and mitigate their state anxiety and labor pain.