引用
臨床因素的消失：台灣剖腹產研究的知識生產政治
The Disappearance of Clinical Factors: Knowledge Production Politics of Cesarean-Section Research in Taiwan
作者：吳嘉苓（Chia-Ling WU） | 首次發表於 2020-06-04 | 第 45 期 December 2010
DOI：https://dx.doi.org/10.6786/TJS.201012_(45).0001
研究論文（Research Articles）
DOI：https://dx.doi.org/10.6786/TJS.201012_(45).0001
研究論文（Research Articles）
論文資訊 | Article information
摘要 Abstract
本文以過去50年來台灣剖腹產成因的學術研究作為分析對象，試圖描述其知識變遷特性，解釋其為何轉變，並分析其後果。主要資料為102篇相關研究論文的內容分析，並輔以檔案資料、國際文獻、深入訪談與參與觀察。本文提出「醫師不再研究臨床因素」，作為台灣剖腹產研究的重大轉變。自1960年代開始，產科醫師以醫院病歷進行調查，在自己的社群進行發表與討論，以胎位不正、前胎剖腹等臨床因素，作為分析重點，並針對產科的技術面提出改進方案。1990年代開始，剖腹產擴大為公共爭議，在知識位階與研究標準的改變下，產科醫師不再從事相關研究。公衛、醫管與健康經濟學家轉而以健保資料庫作為主要分析對象，並著重以婦女行為與制度因素作為主要解釋模型，臨床因素僅為控制變項，並且受到黑盒子化。研究成果的政策意涵也轉為強調檢討健保制度、機構因素以及民眾行為。本文主張打破產科知識作為鐵板一塊的分析模式，看重產科研究對於生產改革的潛在貢獻。本文建議改造知識生產結構，將臨床因素重新納入台灣高剖腹產率的研究重點。才更可能為台灣10多年來高居不下的剖腹產率，建立更清楚的解釋圖像，鋪陳對焦的改革藍圖。
關鍵詞：知識生產、科技與社會研究、臨床因素、剖腹產
關鍵詞：知識生產、科技與社會研究、臨床因素、剖腹產
In this paper I investigate the transformation of knowledge production in researching high cesarean section (CS) rates in Taiwan over the past fifty years. I use the perspectives of science, technology and society studies (STS), and medical sociology to analyze how the social structure of scientific communities and changes in data collection, research tools, research conceptualization, and research modeling have led to this transformation. The primary data include 102 research articles, book chapters, master theses, and reports on high CS rates in Taiwan, plus interviews with 21 researchers and obstetricians. Starting in the 1960s, obstetricians used hospital medical records to document increasing CS rates in specific hospitals, and published their findings in local academic journals. They focused on clinical factors such as breech presentation and previous C-sections, and suggested improvements in obstetric techniques to avoid unnecessary C-sections. In the 1990s, Taiwan’s high CS rate became a widely reported and discussed issue, and obstetricians faced pressure from their peers. In addition, laboratory research started to receive greater academic prestige than studying epidemiological data; therefore CS research by obstetricians came to an almost complete halt. Such studies were replaced by research from the fields of public health, medical administration, and health economics. These efforts relied mainly on National Health Insurance database to study CS trends in Taiwan. Their studies, which treated clinical factors as controlling variables, focused on institutional factors and birth women’s behaviors to construct explanatory models. Here I argue in support of the potential contribution of studies by obstetricians to childbirth reform, and suggest strategies to bring clinical factors back into research efforts on high CS rates in Taiwan.
Keywords: knowledge production, STS, clinical factors, cesarean section
Keywords: knowledge production, STS, clinical factors, cesarean section
