Maternity care in The Netherlands: The changing home birth rate
Maternity care in The Netherlands: The changing home birth rate
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DOI：
10.1046/j.1523-536x.1998.00190.x
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发表时间：
1998-09-01
影响因子：
2.5
通讯作者：
Keirse, MJNC
中科院分区：
文献类型：
--
作者：
Wiegers, TA;van der Zee, J;Keirse, MJNC
1965年，荷兰三分之二的新生儿是在家中出生的。在接下来的25年里，这种情况发生了逆转，超过三分之二的分娩发生在医院，不到三分之一的分娩发生在家中。有几个因素影响了这一变化，包括实行住院分娩、医院为独立助产士提供的设施、从初级保健到二级保健的转诊率增加、参与产妇护理的不同专业人员比例的变化、医疗技术和人口变化。在经历了1978年的下降和1978年至1988年的相对稳定时期后，家庭出生率开始进一步下降，以至于可能会破坏荷兰产妇保健系统和助产士在其中的作用，荷兰产妇保健系统严重依赖主要照顾者、助产士和全科医生，他们负责照顾低风险怀孕的妇女，以及为高危妊娠提供护理的产科医生。要维护这一权利，就需要不同的照顾者之间进行高度合作，并建立一个有效的选择制度，以确保所有妇女都能得到最适合其需要的那种照顾。在荷兰产妇护理系统中保留在家分娩的选择需要保持助产士的高培训和研究生标准，继续提供产妇家庭护理助理，并使怀孕简单的妇女对自己和系统有足够的信心，从而在选择在家分娩时感到安全。
In 1965 two-thirds of all births in The Netherlands occurred at home. In the next 25 years, that situation became reversed with more than two-thirds of births occurring in hospital and fewer than one-third at home. Several factors have influenced that change, including the introduction of short-stay hospital birth, hospital facilities for independent midwives, increased referral rates from primary to secondary care, changes in the share of the different professionals involved in maternity care, medical technology and demographic changes. After a decline lip to 1978 and a period of relative stability between 1978 and 1988, the home birth rate started to decline further, to the extent that it might destabilize the Dutch maternity care system and the role of midwives in it. The Dutch maternity care system depends heavily on primary caregivers, midwives and general practitioners who are responsible for the care of women with low-risk pregnancies, and on obstetricians who provide care for high-risk pregnancies. Its preservation requires a high level of cooperation among the different caregivers, and a functional selection system to ensure that all women receive the type of care that is best suited to their needs. Preserving the home birth option in the Dutch maternity care system necessitates the maintenance of high training and postgraduate standards for midwives, the continued provision of maternity home care assistants, and giving women with uncomplicated pregnancies enough confidence in themselves and the system to feel safe in choosing a home birth.