開業助産師が母乳不足感を抱く母親に行う助産ケアのプロセス

Abstract

目的: 母乳不足感を抱く母親に対する開業助産師の母乳育児支援の過程を明らかにする。方法: 助産師として10年以上の経験がある開業助産師6名に半構造的面接を実施、木下の修正版グラウンテッドセオリーアプローチ法(M-GTA)にて分析した。結果: 11個のカテゴリーと23個の概念が抽出された。開業助産師は【お母さんの心に寄り添う】という信念を基に【早めの介入】を心がけていた。【見極めのための観察】から、【お母さん側の要因】と【赤ちゃん側の要因】を探り、その要因に合わせて、【育児不安を解消する】【赤ちゃんを受け入れてもらう】【お母さんと赤ちゃんの上達】を目指すべく、個々に【少し頑張れば手の届くゴールを設定】していた。【助産師としての自己研鎖を重ねる】ことで【お母さんが望む母乳育児】に近づけていた。考察: 母親の育児不安が緩和され、自信をもって母乳育児を行えるような丁寧な関わりが重要だと考えた。また、母親が挫折感を感じることのないよう、個々に合わせたゴーノレを設定し、少しずつ上を目指し母親の望む母乳育児に近づけることが重要であると示唆された。

OBJECTIVE: The present study aimed to identify the process used by independent midwives when providing breastfeeding support for mothers who have a feeling of breast milk shortage. METHOD: Semi-structured interviews were conducted on six independent midwives with over 10 years of experience working as midwives. The contents of the interviews were then analyzed using the modified grounded theory approach. RESULTS: The results of the analysis identified 11 categories and 23 concepts. The independent midwives practiced "early intervention" based on their belief in "providing emotional support to the mothers", and “observed to determine" whether the issue was a lack of breast milk or a feeling of breast milk shortage. They also searched for “factors related to the mothers" and “factors related to the babies". By catering to one of these factors, they attempted to “relieve mothers' child-rearing anxieties", “encourage mothers to accept their babies", and “assist in improving the breastfeeding skills of mothers and babies". The independent midwives also “established goals that were achievable with a litte bit of effort" that were individualized for each mother, and moved closer to providing "breastfeeding practices sought after by the mothers" by “continuously working on self-improvement as a midwife". DISCUSSION: The results of the present study highlight the importance of offering a considerate approach by midwives in alleviating the child-rearing anxieties of mothers so that the mothers feel confident in breastfeeding. The results also suggest the importance of the following: i) establishing individual goals for each mother so that mothers do not feel a sense of failure; ii) mothers and midwives attempting to improve their level of understanding together; and iii) moving closer to providing breastfeeding practices sought after by the mothers.