精神障害のある特定妊婦の問題と訪問助産師による支援

Abstract

精神障害のある特定妊婦を訪問し支援を行う助産師が捉えた特定妊婦の問題と助産師による支援の現状を明らかにすることを目的に，特定妊婦を訪問する助産師10名に半構成的面接を行った。 質的データより訪問する助産師が捉えた精神障害のある特定妊婦の問題と訪問助産師の支援を抽出し， SCATによる分析を行った。分析事例は10例であった。精神障害のある特定妊婦は，心身症状の管理困難，子どもの生命を守る育児力不足，意思疎通困難，育児環境の整備困難支援的な家族の欠如，就労困難による経済的困窮の問題がみられた。これらの問題に対し助産師は，特定妊婦の精神症状に対応した支援的関係の構築に努め，母体の健康安定支援，子どもの安全な成長発育支援，家族のサポートカのエンパワメントを行っていた。一方で精神障害の特性によるコミュニケーション困難，多職種連携の非構築を感じていた。支援する上では，精神症状を理解した対応スキルの向上，多職種連携における支援目的の共有と連携の見直しが必要である。

This study aimed to identify the problems of pregnant women and mothers with mental disorder and the social support they receive from midwives. Semistructured interviews of 10 midwives who visited pregnant women and mothers with mental disorders were conducted. The Steps for Coding and Theorization method was used to analyze the qualitative date obtained after identifying the problems faced by pregnant women and mothers with mental disorders and the social support provided to them. The problems faced by pregnant women with mental disorders include difficulty in managing physical and mental health, communication disorder, lack of parenting skills to protect their children's lives, difficulty in creating and environment suitable for childcare, lack of family support, and financial instability caused by inability to work. The midwives established a relationship with the mothers based on their psychiatric symptoms and provided support to help them maintain a good physical and mental state of mind. They also assessed the child's safety and development and provided parenting guidance to the family. While providing support, the midwives found it difficult to cope with the mothers' psychiatric symptoms and collaborate with various professions. In providing support, it is necessary to improve understanding of psychiatric symptoms and response skills, and to share the purpose of support and review collaboration in multidisciplinary cooperation.