Stomal Therapy, Level 1 West, Concord Repatriation General Hospital, Sydney, NSW, Australia.
Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia.
J Clin Nurs. 2018 Nov;27(21-22):3931-3944. doi: 10.1111/jocn.14601. Epub 2018 Jul 26.
To understand women's experience of pregnancy with an ileostomy following bowel resection for inflammatory bowel disease or familial adenomatous polyposis.
While symptoms of IBD/FAP can be debilitating and life-threatening, ostomy formation can effectively manage symptoms. Research on pregnant women with an ostomy is sparse. While some literature suggests pregnant women with an ostomy can have a normal pregnancy and birth, documented stoma complications include intestinal obstruction, peristomal hernia, retraction, stenosis, laceration, bleeding, prolapse, pouching problems, nausea, vomiting and dehydration.
Hermeneutic phenomenology.
All known women (n = 8) who had been pregnant with an ileostomy were recruited from the stomal therapy departments of two teaching hospitals. Single in-depth interviews were digitally recorded and transcribed verbatim. Hermeneutic phenomenological analysis was guided by the philosophy of Merleau-Ponty. Reporting rigour was guided by the consolidated criteria for reporting qualitative research.
There was a lower level of concern among pregnant woman with an ostomy than anticipated. Women described the following: the "hell" of the disease; the stoma as a lifeline; heading into uncharted waters; wanting to be normal; the shared space of the baby and the diseased abdomen; pregnancy as a dark tunnel; and the unreliable body.
Women with inflammatory bowel disease frequently experience debilitating symptoms and serious ill health. Ileostomy formation improves symptoms and the sense of "feeling normal," facilitating readiness for conception, pregnancy and motherhood. However, women's uncertainty about conception and pregnancy persists due to the scarce information and experiences offered by clinicians, and fears around their unreliable body during pregnancy. Given this uncertainty for both women and their treating clinicians, outcomes should be documented and shared to reassure women of child-bearing age that pregnancy and birth can be safe with a stoma.
Women and clinicians should aim for disease remission, peer support, ongoing monitoring and involvement of a Stomal Therapy Nurse.
了解因炎症性肠病或家族性腺瘤性息肉病而行肠切除术并带有回肠造口的女性在怀孕期间的体验。
虽然 IBD/FAP 的症状可能使人虚弱并危及生命，但造口术可以有效地控制症状。有关带造口怀孕的女性的研究很少。虽然一些文献表明带造口的孕妇可以正常妊娠和分娩，但有记录的造口并发症包括肠梗阻、造口疝、回缩、狭窄、撕裂、出血、脱垂、袋状问题、恶心、呕吐和脱水。
解释学现象学。
从两家教学医院的造口治疗部门招募了所有已知（n=8）曾怀有回肠造口的女性。对每位女性进行了单独的深入访谈，并进行了逐字记录和转录。现象学解释学分析以梅洛-庞蒂的哲学为指导。根据定性研究报告的统一标准来指导报告的严谨性。
带造口的孕妇的担忧程度低于预期。女性描述了以下内容：疾病的“地狱”；造口是生命线；踏入未知水域；想要正常；婴儿和患病腹部的共享空间；怀孕是黑暗的隧道；以及不可靠的身体。
患有炎症性肠病的女性经常经历使人虚弱的症状和严重的健康问题。回肠造口术改善了症状和“正常感”，为受孕、怀孕和成为母亲做好了准备。然而，由于临床医生提供的信息和经验有限，以及孕妇对自己不可靠身体的担忧，女性对受孕和怀孕的不确定性仍然存在。鉴于女性及其治疗医生的这种不确定性，应该记录和分享结果，以向育龄女性保证，即使带有造口，怀孕和分娩也可以是安全的。
女性及其临床医生应该致力于疾病缓解、同伴支持、持续监测和造口治疗护士的参与。
