산전교육(産前敎育)이 분만진통(分娩陣痛)에 미친 효과( 效果)에 관한 일연구(一硏究)

Abstract

[한글]

본 연구는 正常分娩中에 산부가 경험하는 진통을 완화할 수 있는 한가지 방법이라고 가정한 산전교육을 初産婦에게 실시하고 그 效果를 측정하였다.

연구목적은 분만진통에 영창을 미친 要因을 확인하고 분만진통의 내용을 규명하며 산전교육의 효과를 확인하는 것이었다.

연구방법은 1982년 12월 9일부터 1983년 3월 31일까지 病院과 助産所에서 正常分娩한 80명의 초산부를 대상으로 실험군과 통제군으로 나누어 면접과 관찰방법을 통해 자료를 수집하였다.

연구도구는 문헌조사를 통해 著者가 선정 적용하였고 사건에 신뢰도와 타당도 검정을 거친 진통측정 도구, 지식측정, 痛症耐忍性, 痛症爛値, 初産婦의 특성들로 구성된 통제변수 측정도구와 실험처치를 위해 산전교육자료를 사용하였다.

수집된 자료의 분석은 분만진통 변수에 영향을 미친 요인을 확인하기 위하여 t검정, 분산분석, 피어슨(Pearson) 상관분석으로 검정하였다. 분만진통의 내용을 규명하기 위하여는 요인분석(Factor Analysis)을 실시하였다. 산전교육의 효과를 확인하기 위하여 실험군

과 통제군간의 차이 검정은 x**2 -test , t검정을 이용하여 분석하였으며, 가설검정을 위해 t검정을 사용하였다. 실험군과 통제군간에 유의한 차이가 있었던 변수와 실험처치를 독립변수로 하여 이원분산분석 (two-way-ANOVA)을 실시하였다.

연구의 결과를 요약하면 다음과 같다.

(1) 분만진통에 영향을 미친 제 요인

분만진통에 영향을 미친 요인은 초산부의 개인특성 13개 항과 資料收集過程에서 발생된 변수 7개 항을 종속변수인 통증강도, 통증척도, 통증표현, 생리적 활력 징후 각각과 관계를 분석하였다. 분석 결과 p< .05 수준에서 유의한 차이가 있는 내용만을 설명하였는데 대부분의 분만진통 측정치에 영창을 미친 요인은 障痛表現牧集者, 分擺介助者, 予宮收縮製 投與, 分娩場所인 것으로 나타났다.

(2) 분만진통의 내용규명

분만진통측정치를 경관개대 2 - 3㎝, 5 - 6㎝, 9 - lO㎝시에 측정치로 분류하여 요인분석을 하였다.

2 - 3㎝개대 , 5 - 6㎝개대, 9 - lO㎝개대시 분만진통측정도구로 이용된 각각 10개씩 총 30개의 요인은 매 측정시 마다 통증강도, 통증척도, 통증표현의 6개 요인과 맥박과 호흡 2개 요인이 동질의 요인으로, 혈압 2개 요인이 동질의 요인으로 분류되었다.

(3) 산전교육의 效果

산전교육의 효과를 확인하기 위하여 실험군과 통제군 간에 분만진통 측정치를 비교 분석하여 가설검정한 결과는 다음과 같다.

재 1부 가설인 산부가 경험하는 통증강도는 실험군이 통제군보다 낮을 것이다는 지지되었다.

제 2부가설인 산부가 경험하는 통증척도는 실험군이 통제군보다 낮을 것이다는 지지되었다.

제 3부가설인 산부가 경험하는 痛症表現인 發汗程度, 顔面움직임, 身體姿勢, 聲音變化는 실험군이 통제군보다 측정치 정수가 낮을 것이다는 부분적으로 지지되었다.

제 4부가설인 산부가 경험하는 生理的 活力(활력)징후인 血壓, 脈膊, 呼吸은실험군이 통제군보다 낮을 것이다는 부분적으로 지지되었다.

[영문]

The purpose of this study was to examine the effects of childbirth preparation on relief of labor pain.

In order to test the effects of the childbirth preparation on labor pain, four hypotheses were formulated as follows:

Main hypothesis ; Those who receive preparation for childbirth (experimental group) will have lower labor pain score than those who do not receive preparation (control group).

Sub-Hypotheses ;

1) The degree of the intensity of the labor pain will be lower In the experimental group than in the control group.

2) Self rating score of the labor pain will be lower in the experimental group than in the control group.

3) The scores of expression of the labor pain (Perspiration, Facial movement, Position change, Change of voice) wall be lower in the experimental group than in the control group.

4) The scores related to the vital signs of physiological changes will be lower in the experimental group than in the control group.

In this study pain, theories and traditional methods of relieving labor pain were reviewed. The Contemporary Gate Control Theory of Pain recognizes that psychological variables play an important role in pain experiences. Previous empirical studies explored that labor pain was relieved by breathing, antenatal exercises, reassurance, distracts etc. Another way of relieving pain is the utilization of the conditioning theory of Pavlov.

Methodology :

1) To test those formulated hypotheses, data were gathered from eighty women in labor at one general hospital and one midwifery clinic in Seoul area. Forty subjects were assigned to each group (experimental group and control group) by systematic way. At the antenatal clinics in each place, the child birth program was largely based on Lamaze breathing techniques and administered to the experimental group was structured and consisted of a 16 minutes tape record, 43 slides and related discussion and the giving out of manuals that the group members could read and study at home.

2) During their visit for antenatal care between 36-40 weeks of pregnancy, subjects in both groups were tested for pain tolerance and pain threshold by chocking blood pressure (systolic and diastolic) with an aneroid cuff, and the knowledge of the progress of labor before administration of the program.

3) When those same subjects came to the labor room for delivery, trained personnel began to observe and check labor pains at different phases according to Friedman's labor curve ;

2 - 3 ㎝ cervical dilatation of the Os : latent phase

5 - 6 ㎝ 〃 〃 〃 : active phase

9 -10 ㎝ 〃 〃 〃 : transition phase

4) Subjects in both groups were asked to express their severest pain in one word within 24 hours of delivery.

Summary of the results of study are as follows:

Hypothesis 1 ; " Thee degree of the intensity of the labor pain will be lower in the experimental group than in the control group " was supported.

Hypothesis 2 ; " Self rating score of the labor pain will be lower in the experimental group than in the control group " was supported .

Hypothesis 3 ; " The scores of expression of the labor pain (perspiration, facial movement, position change, change of voice) wi11 be lower in the experimental group than in the control group" was partly supported. The part dealing with the change

of position and change of voice was lower in the experimental group but the part having to do with the facial movement and perspiration was not significantly lower in the experimental group.

Hypotheses 4 ; " The scores related to the vital signs of physiological changes will be lower in the experimental group than in the control group" was supported in regard to blood pressure and pulse rate but in regard to respirations at phase 9 - 10㎝ dilatation of the cervical Os was not significantly lower in the experimental group.

Childbirth is a natural phenomena what is influenced by interpersonal relationships with doctors, nurses, midwives and husbands, relatives and the environment where birth takes place. In order to break the cycle of fear-tension-pain, psychological care and education are helpful. Therefore nurses as educators, researchers and clinical practitioners should develop educational

programs and employ them for women in labor for relief of pain.