보조생식술을 받은 여성의 선택적 감수술에 대한 의사결정 경험

Abstract

Infertility treatment could lead to higher-order multiple pregnancies, which, in turn, induce an issue of multifetal pregnancy reduction to improve the perinatal outcome for mothers and infants. However, such decisions lead to further difficulties and conflicts for couples trying to treat infertility, and their families. Despite the growing rate of infertility in this country, there have been only a few studies in nursing with a focus on decision-making for multi-fetal pregnancy reduction. This study aims to explore and more fully understand the experience of decision-making to undergo or forgo multifetal pregnancy reduction for women who have conceived their higher-order multiple pregnancies through assisted reproductive technology treatment. After obtaining the approval of the Seoul National University Human Subjects Review Board, data were gathered from August to October 2013. For recruiting the participants, three online communities related to twin pregnancy and individual contacts were used. Sampling continued until data saturation was reached, based on the potential richness of the data. All interviews were audio-recorded digitally and transcribed verbatim. A total of 9 in-depth interviews and 2 telephone interviews were analyzed. All the women had conceived after an average of two years of assisted reproductive technology treatment. The current higher-order multiple pregnancies were the first birth for most of them. About half of the participants had attempted to become pregnant more than once, and had experienced the loss of a baby due to premature birth and spontaneous abortion before the current pregnancy. Using the thematic analysis method of Braun and Clarke, initial code of 156 items was reduced to 12 sub-themes. Then, these sub-themes were abstracted to create higher-order themes, finally 6 core themes were identified and carefully named. The themes were (1) confusion after higher-order multiple pregnancy

(2) obstacles to choice: safety of the baby

(3) dilemma for choice: weighing burden and responsibility

(4) influences of medical professionals

(5) choice by following the heart

(6) things come after decision. The results show a wide range of factors experienced by women considering multifetal reduction, and reveal mothers feelings of conflict and distress in the process of making a decision. These findings will be useful to help nurses improve the counseling they offer to those who go through the decision-making process. Moreover, the findings suggest that it is important for nurses to provide emotional support and consolation, as well as sufficient information. Consideration should be given not only to the assisted reproductive technology treatments but also to offering couples childcare assistance. A discussion to strengthen ethics of medical professionals in relation to infertility treatments is also necessary, so that infertile couples can take an active and proactive part in their own family planning for the future. Thus, infertile couples must receive the necessary assistance and support in order to experience a sense of happiness without a sense of loss in the course of infertility treatment.