THE ISSUE OF JAPANESE MATERNITY SURVICES IN RELATIONS TO INDEPENDENT MIDWIVES AND HOSPITALS AFTER 2007 FROM THE MIDWIVES' VIEW.

修订后的《医疗服务法》规定，有床位的妇产科诊所必须指定一名签约产科医生和一家签约医院，在紧急情况下提供协助和/或为妇女提供健康检查。没有床位的产科诊所不受新的医疗服务法的管制，本研究的目的是描述助产士建立产科诊所的经验。参与者包括2003年至2009年建立产科诊所的23名助产士。从2007年到2009年，使用半结构化访谈收集数据。这项研究获得了日本红十字会护理伦理委员会的批准。23名助产士中有12名建立了有床位的产科诊所，11名助产士建立了无床位的产科诊所。一名接生员负责在家中分娩，她在那里提供怀孕和哺乳咨询方面的健康指导。几乎所有助产士都提供从怀孕到产后的连续性护理。此外，助产士通常 关于我们 我会雇用1或2名额外的助产士，以帮助只有分娩。助产士每年接生1-80名婴儿。所有23名参与者都指定了合同医院，但签署的协议条件差异很大。有些医院要求孕妇在怀孕期间必须去医院做2-3次体检，所有的体检和生产都由助产士负责，有些医院甚至不签正式的合同，只是口头协议。只做上门服务和有计划的上门分娩的助产士不需要指定一名签约产科医生，因此许多人不这样做。然而，如果妇女本人愿意，可以请一名“合作产科医生”，该产科医生只会支持这一名妇女。助产士一般同意这一点，终身助产士没有麻烦找到产科医生来支持她的妇女。然而，农村地区的助产士很难做到这一点，因为产科诊所附近没有产科医生。少

The revised Medical Service Law states that Maternity clinics with bed must appoint a contracted obstetrician and a contracted hospital that shall assist in emergencies and/or offer health checkups to the women. Maternity clinics that do not have beds are not regulated by the new Medical Service Law.The purpose of this research is to describe experiences of midwives establishing their maternity clinics. Participants included 23 midwives who established maternity clinics from 2003 to 2009. Data were collected using a semi-structured interview from 2007 to 2009. This study was granted approval by the Japanese Red Cross College of Nursing Ethics Committee.12 of 23 midwives established maternity clinics with beds, 11 midwives established them without beds. A midwife dealing with home birth had a facility, but she provided health guidance for pregnant and breastfeeding consultation there. Almost all midwives provide continuity care through pregnancy to postpartum. In addition, midwives usua … More lly employ 1 or 2 additional midwives to help with deliveries only. Midwives delivered from 1-80 babies per year.All 23 participants appointed contracted hospitals, however the signed agreements conditions varied widely. Some hospitals required that the women had to go to the hospitals for 2-3 health checkups during pregnancy, leaving all health checkups and the delivery mainly to the midwive.In some cases, hospitals wouldn't sign any official contract but instead just gave a verbal agreement. Midwives that do only home calls and planned home deliveries do not need to appoint a contracted obstetrician and thus many do not do so. However, if the woman herself wishes so, a 'Cooperator Obstetrician' can be called on and that Obstetrician will only support that one woman. Midwives generally agree on this, and tenured midwives had no trouble finding Obstetricians to support her women. However, midwives in rural had trouble doing so because there were not any obstetrician near the maternity clinics. Less