고령 초임부의 모의 분만체험 프로그램 개발 및 효과

Abstract

This study was performed to develop a simulation program of labor and delivery experience and verify its effects on elderly primigravidas (women pregnant for the first time). This study had a nonequivalent control group pretest-posttest design. Data were gathered from June 10 to September 30, 2015, and a total of 49 subjects (25 in the experimental group and 24 in the control group) were included. All statistical analyses were conducted using SPSS/WIN 21.0 Program. The chi-square test and Fisher's exact test were used as pre-homogeneity tests, t-test to verify homogeneity of dependent variables, independent t-test to test hypotheses, and Cronbach's α to assess chi-square reliability. The results of this study are as follows: 1) The first hypothesis, “the degree of anxiety would be lower in the experimental group who participated in the simulation program of labor and delivery experience than in the control group who did not participate in the program,” was verified. After participation, a difference in mean values between the two groups was 0.38, showing a significant difference (t=-3.31, p=. 002). Therefore, the first hypothesis was supported. 2) The second hypothesis, “the degree of pregnancy stress would be lower in the experimental group who participated in the simulation program of labor and delivery experience than in the control group who did not participate in the program,” was verified. After participation, a difference in mean values between the two groups was 0.44, suggesting a significant difference (t=-4.58, p=<.001). Therefore, the second hypothesis was supported. 3) The third hypothesis, “the level of knowledge of childbirth would be higher in the experimental group who participated in the simulation program of labor and delivery experience than in the control group who did not participate in the program,” was verified. After participation, a difference in mean values between the two groups was 3.32, indicating a significant difference (t=5.92, p=<.001). Therefore, the third hypothesis was supported. 4) The fourth hypothesis, “the level of childbirth self-confidence would be higher in the experimental group who participated in the simulation program of labor and delivery experience than in the control group who did not participate in the program,” was verified. After participation, a difference in mean values between the two groups was 0.96, representing a significant difference (t=8.10, p=<.001). Therefore, the fourth hypothesis was supported. 5) The fifth hypothesis, “the attitude toward labor outcomes would be more positive in the experimental group who participated in the simulation program of labor and delivery experience than in the control group who did not participate in the program (involving only normal delivery),” was verified. 5-1: “The length of labor would be shorter in the experimental group than in the control group” was verified. After participation, the average length was 7.50 hours in the experimental group and 9.92 hours in the control group. The mean difference between the two groups was 2.42, showing a significant difference (t=-2.13, p=<. 001). Therefore, hypothesis 5-1 was supported. 5-2: “The number of women having a painless childbirth would be smaller in the experimental group than in the control group” was verified. After participation, a significant difference was found in the use of painless delivery between the two groups (x²=.011, p=<.011). Therefore, hypothesis 5-2 was supported. 5-3: “The level of perception on childbirth experience would be higher in the experimental group than in the control group” was verified. After participation, the mean for perception of childbirth experience was 2.78 with a SD of 0.46 in the experimental group and 2.57 with a SD of 0.21 in the control group. The mean difference between the two groups was 0.21, showing a statistically significant difference. Therefore, hypothesis 5-3 was rejected. Based on the above study findings, the simulation-based program of labor and delivery experience for elderly primigravidas is verified to improve childbirth outcomes. Therefore, as the average age at which first time mothers give birth is continually rising, measures to expand and distribute this program need to be devised for older primigravidas to ensure safe childbirth and healthy children.

본 연구는 고령 초임부의 모의 분만체험 프로그램을 개발하고 적용하여 그 효과를 검정하기 위한 목적으로 실시되었다. 연구 설계는 비동등 대조군 전후 설계(nonequivalent control group pretest-posttest design)로 실시하였다. 자료수집기간은 2015년 6월 10부터 9월 30일까지 이루어졌으며, 연구대상은 실험군 25명, 대조군 24명으로 총 49명이었다. 자료분석은 SPSS/WIN 21.0 Program을 이용하였고, 사전 동질성 검정은 Chi-square test, Fisher's exact test를 이용하였으며, 종속변수의 동질성 검증은 t-test, 가설검정은 independent t-test, Chi-square test 신뢰도는 Cronbach’s α를 이용하였으며, 연구결과는 다음과 같다. 1) 제 1가설: ‘모의 분만체험 프로그램에 참여한 실험군은 참여하지 않은 대조군보다 분만에 대한 불안정도가 낮을 것이다.’를 검증한 결과, 실험군과 대조군의 불안에 대한 프로그램 참여 후 평균값의 차이는 0.38로 유의한 차이가 있었다(t=-3.31, p=. 002). 따라서 제 1가설은 지지되었다. 2) 제 2가설 ‘모의 분만체험 프로그램에 참여한 실험군은 참여하지 않은 대조군보다 분만에 대한 임신스트레스 정도가 낮을 것이다.’를 검증한 결과, 실험군과 대조군의 임신스트레스에 대한 프로그램의 참여 후 평균값의 차이는 0.44로 유의한 차이가 있었다(t=-4.58, p=<.001). 따라서 제 2가설은 지지되었다. 3) 제 3가설 ‘모의 분만체험 프로그램에 참여한 실험군은 참여하지 않은 대조군보다 분만지식이 높을 것이다.’를 검정한 결과, 실험군과 대조군의 분만지식에 대한 프로그램의 참여 후 평균값의 차이는 3.32로 유의한 차이가 있었다(t=5.92, p=<.001). 따라서 제 3설은 지지되었다. 4) 제 4가설 ‘모의 분만체험 프로그램에 참여한 실험군은 참여하지 않은 대조군보다 분만자신감이 높을 것이다.’를 검정한 결과, 실험군과 대조군의 분만자신감에 대한 프로그램의 참여 후 평균값의 차이는 0.96으로 유의한 차이가 있었다(t=8.10, p=<.001). 따라서 제 4설은 지지되었다. 5) 제 5가설 ‘모의 분만체험 프로그램에 참여한 실험군은 참여하지 않은 대조군보다 분만결과에 대해 더 긍정적일 것이다.’(정상분만만 분석) 5-1: ‘실험군은 대조군보다 분만소요시간이 짧을 것이다.’를 검정한 결과 참여 후 분만소요시간에 대한 비교에서 실험군은 7.50시간으로 나왔고 대조군은 9.92 시간으로 나왔으며 이들 평균값의 차이는 2.42로 유의한 차이가 있었다(t=-2.13, p=<.001). 따라서 가설 5-1은 지지되었다. 5-2: ‘실험군은 대조군보다 무통분만빈도가 낮을 것이다.’를 검증한 결과 실험군과 대조군의 분만결과에 대한 프로그램 참여 후 무통분만 사용유무는 유의한 차이가 있었다(x²=.011, p=<.011). 따라서 가설 5-2는 지지되었다. 5-3: ‘실험군은 대조군보다 분만경험지각이 높을 것이다.’를 검정한 결과 실험군의 분만경험지각의 평균은 2.78, 표준편차는 0.46로 나타났으며, 대조군의 평균은 2.57, 표준편차는 0.21로 나타났으며, 두 집단의 평균차이는 0.21로 통계적 유의한 차이는 없는 것으로 나타났다. 따라서 가설 5-3은 기각되었다. 이상의 결과로, 시뮬레이션 이론에 기반을 둔 모의 분만체험 프로그램은 고령 초임부의 분만결과를 향상시키는 것으로 검정되었다. 따라서 고령임부가 지속적으로 상승하고 있는 시점이므로 안전한 분만과 건강한 미래의 자원을 위해 확대, 보급될 수 있는 방안이 모색되어야 할 것이다.