| Abstract: | 研究目的：母職經驗對於?性自我的形塑扮演重要的角色，從母職相關事務中體現不同於以往的存在價值，而哺乳為女性為人母過程重要的一部分。接受體外受精協助受孕婦?在確認?孕、接受治?到懷孕生產的經驗和需求?同於自然懷孕母親，本研究目的在於(1)了解接受體外受精協助受孕婦女的自我概念於產前和產後的變化；(2)比較接受體外受精協助受孕和自然懷孕二組婦?的母乳哺餵經驗；(3)母乳哺餵經驗對於接受體外受精協助受孕婦?自我概?之影響。
研究方法：本研究採前瞻性個案對照研究設計，以立意取樣分別於台中市某生殖醫學中心與某醫學中心婦產部門診招募研究對象，共計89名接受體外受精協助受孕之初次懷孕生產婦女和142名初次自然懷孕生產婦女參與研究。於研究對象懷孕第28週至產前(T0)、產後第2週(T1)、產後三個月(T2)分別以結構式問卷收集資料，研究工具包括田納西自我概??表(自我批評、自我總分、生理自我、倫理道德自我、心理自我、家庭自我、社會自我、學業/工作自我、自我認同、自我滿意和自我行動)、愛丁堡周產期憂鬱?表和母乳哺餵經驗量表。所得資料回收後以獨立樣本t檢定、卡方檢定、廣義估計方程式、皮爾森積差相關和階層迴歸分析進行統計分析。
研究結果：
(一) 接受體外受精協助受孕婦女T0時的「道德倫理自我」平均值顯著高於自然懷孕婦女，然在T2時，二組婦女的差異程度未達顯著水準。接受體外受精協助受孕婦女自我總分及其他次量表分數的平均值從T0至T2的變化未達顯著水準，且與自然懷孕婦女間並無顯著差異。
(二) 不同受孕方式在T1時的哺餵方式無顯著差異；T2則有顯著差異，T2有持續哺餵母乳的接受體外受精協助受孕婦女以配方奶為主搭配母乳佔多數24名(50.0%)，其餘依序為純母乳哺餵14名(29.2%)和母乳為主混合配方奶10名(20.8%)。接受體外受精協助受孕婦女在T1和T2的母乳哺餵經驗平均值，分別與自然懷孕婦女間均無顯著差異。
(三) 階層迴歸分析顯示，T0自我概念對T2自我概念呈正向影響，T2憂鬱傾向對T2自我概念則負向影響；控制T0自我概念和T2憂鬱傾向的影響之後，T2母乳哺餵經驗對於T2自我概念有顯著負向影響，特別是反映於自我總分、生理自我、學業/工作自我和自我行動；母乳哺餵經驗和受孕方式的交互作用對於自我概念則無顯著解釋力。
結論與建議：接受體外受精協助受孕婦女在第三孕期對於自我有較高的滿意度，為產後自我概念的保護因子；然在母乳哺餵經驗中所遭遇的困難愈多，對於婦女產後自我概念造成的威脅即愈大。研究結果可提供臨床照護人員瞭解體外受精協助受孕婦女為人母時的身心經驗，與自我概念趨勢間的關係，提供護理照顧與心理諮商的參考。
Purpose：Mothering plays an important role in shaping of women's self and the value of existence. Breastfeeding is an important part of the maternal tasks. There are differences in experience and needs between women undergoing In Vitro Fertilization (IVF) and women with spontaneous pregnancy from infertility diagnosis, treatment, conception to delivery. However, literature about influences of breastfeeding on women’s self-concept has been limited previously. The aims of this study are (1) to explore the change of women`s self-concept after IVF from pregnancy to postpartum, (2) to compare the breastfeeding experience of two groups which consist of women received IVF and women with spontaneous pregnancy, and (3) to explore the impact of breastfeeding experience on the women`s self-concept after IVF.
Method：In this study, a prospective case-control study design with constructive self-reported questionnaire is conducted at the third trimester pregnancy (T0), two weeks postpartum (T1) and the third months postpartum(T2), and to compare with women conceived spontaneously. The measurement tools included the Breastfeeding Experience Scale, the Tennessee Self-Concept Scale, and the Edinburgh Depression Scale. 89 women who were successfully pregnant after IVF and 142 women who conceived spontaneously were recruited from a reproductive medicine center and obstetrics department of a medical center in Taichung City. Using the t-test, Chi-square test, Pearson correlation, hierarchical regression analysis, and generalized estimation equation as a statistical analysis method.
Result：
(1) The results revealed that the “ moral-self ” at T0 was significantly higher in women who received IVF than in women conceived spontaneously, but no significant difference between two groups at T2 was observed. Also, there was no significant change in the trend of self-concept from T0 to T2 in women who received IVF, and neither was a significant difference between two groups.
(2) There was no significant difference in feeding-methods at T1 between groups; however at T2, significant difference was detected between two groups. Among women undergoing IVF who continued to breastfeed at T2, mostly choosed formula-based with breast milk methods(50%), followed by exclusive breastfeeding (29.2%) and breast milk-based with formula methods (20.8%). There was no significant difference in the breastfeeding experience at T1 and T2 between two groups.
(3) The self-concept at T2 were significantly positively correlated with the self-concept at T0, and were significantly negatively correlated with the maternal distress at T2. After controlling self-concept at T0 and maternal distress at T2, the breastfeeding experience were significantly negatively correlated with total self-concept score, physical self, academic self and self behavior postpartum, but no significant difference was observed between two groups for the impact of breastfeeding experience on the women`s self-concept.
Conclusion：In the third trimester, women who received IVF had higher levels of satisfaction with self which can act as a protective factor during the postnatal period. The more difficulties in the breastfeeding experience women encounter , the greater the threat to their self-concept during the postnatal period will be. The results presented in this study will aid clinical professionals to understand the mental health needs of women who conceive IVF and their impact on self-concept, which can provide nursing care and psychological consultation. |
