Doctoral Dissertation Research: A Comparative Study of Home Health Care in the United States and the Netherlands

本文的研究完成了对当代家庭医疗保健的民族志实地研究。特别是在家分娩？在美国和荷兰。与同样发达的国家相比，美国和荷兰在产妇护理组织方面都是异常值。在大多数发达国家，分娩在医院进行，医院助产士提供初级保健，医生处理复杂病例。然而，在美国，助产士的利用率相对较低，90%以上的分娩都是由医生接生的。在家分娩在美国极具争议，有11个州完全禁止这种做法。另一方面，在荷兰，家庭分娩和独立助产是主流产科护理的重要组成部分。医生和助产士有正式的合作安排，近年来，30%的分娩是在家里进行的。考虑到这些不同的文化和制度安排，本调查提出了一个问题：在美国和荷兰，在家分娩意味着什么？生育实践和社会机构（如专业组织、保险系统、政府卫生机构和法律）如何塑造家庭分娩并影响其意义？相对于更广泛的医疗保健系统（例如，纳入或边缘化），家庭分娩的位置如何影响妇女的自主权、权力和能动性？更广泛的影响：这项跨国研究将促进对医学化的理论理解，这一过程与妇女特别相关。我的人生经历。它还将审查和提供关于医药和保健的知识，作为以性别方式发展的文化产品。此外，它还为美国学者、政策制定者和产妇提供了对荷兰产妇保健系统的系统而严谨的分析，可以为有关美国医疗保健未来的辩论提供信息。在医疗保健系统中，必须关注成本控制、安全和病人满意度，荷兰的家庭医疗保健系统可以学到很多东西。

SES-0802483Phyllis MoenRachel KulickUniversity of MinnesotaThis dissertation research completes an ethnographic field study of contemporary home health care ? specifically home birth ? in the United States and the Netherlands. In comparison to similarly developed countries, the U.S. and the Netherlands are both outliers with respect to the organization of maternity care. In most developed countries, birth takes place in hospitals, hospital-based midwives provide primary care, and physicians manage complicated cases. In the U.S., however, midwives are relatively underutilized and physicians attend more than 90 percent of all births. Home birth in the U.S. is extremely controversial and eleven states ban the practice entirely. In the Netherlands, on the other hand, home birth and independent midwifery are essential components of mainstream maternity care. Physicians and midwives have formal arrangements for collaboration and, in recent years, 30 percent of births have taken place at home. Given these distinct cultural and institutional arrangements, this investigation asks: What does it mean to give birth at home in the U.S. and the Netherlands? How do birth practices and social institutions (e.g., professional organizations, insurance systems, government health agencies, and the law) shape home birth and influence its meaning? How does the location of home birth with respect to the broader health care system (e.g., incorporated or marginalized) affect the autonomy, power, and agency of women? Broader Impacts: This cross-national study will advance theoretical understanding of the medicalization, a process especially relevant to women?s life experiences. It will also examine and provide knowledge about medicine and health care as cultural products, developed in gendered ways. Moreover, it brings a systematic and rigorous analysis of the Dutch maternity care system to U.S. scholars, policymakers, and birthing women that can inform debate on the future of U.S. health care. In a health care system necessarily concerned with cost containment, safety, and patient satisfaction, much can be learned from the Dutch system of home health care.