A Study of Analyzing the Japanese Collaboration Model during Labor between Obstetricians and Midwives at Hospitals

本研究提出产科医师与助产士合作模式之假设。该模型解释了以下情况。助产士持续或间歇地观察和照顾孕妇。通常她会将观察数据报告给产科医生。有时，产科医生使用来自助产士的信息数据。有时候产科医生会直接观察。如果助产士持续护理，并且孕妇是低风险的，那么助产士对孕妇有很多信息，所以她决定如何护理孕妇。如果助产士是间歇性地进行护理，助产士就没有太多的信息，所以产科医生倾向于直接收集信息。但是，如果情况变得高风险，产科医生就医疗干预做出决定，因此产科医生依赖于他/她自己的数据，无论助产士的护理是连续的还是间歇的。对模型的分析，我们采取了四个分析过程。首先，我们重新分析了1999年收集的44家医院的数据，其次，我们对一所大学医院和一家大型私立医院的进展图样本进行了案例分析，第三，我们调查了日本300多张病床的医院中产科医生和护士助产士之间的合作情况。第四，我们假设助产士在分娩过程中对孕妇进行“监测”。我们的分析结果表明，产科医生和助产士谁在日本医院工作的低风险孕妇和高风险的妇女在复杂和困难的工作情况下采取合作照顾。在未来，我们希望确定这些合作的有效性，为母亲和儿童创造更好的照顾环境。

We made the hypothesis about the collaborative model between obstetricians and midwives to care the pregnant women during labor. The model explains following situations. The midwife observes and takes care of the pregnant women continuously or intermittently. Usually she reports that observation data to the obstetrician. Sometimes the obstetrician uses the information data from the midwife. Sometimes the obstetrician observes directly. If the midwife takes care continuously and the pregnant woman is low-risk, the midwife has much information of the pregnant woman, so she makes decisions about how to care for the pregnant women. If the midwife takes care intermittently, the midwife doesn't have much information, so the obstetrician tends to gather the information directly. But if the situation becomes high-risk, the obstetrician makes decisions about the medical intervention, so the obstetrician depends upon his/her own data whether the midwife's care is continuously or intermittently. To analyze the model, we took four analyzing process. First we re-analyzed our 44 hospitals data gathered in 1999, second we made case analysis of the samples of the progress charts at a university hospital and a big size private hospital, and third we surveyed the collaborative situations between obstetricians and nurse-midwives in hospital that has over 300 beds in Japan. And forth, we hypothesized "monitoring-c are" for the pregnant women during labor by midwives. The results of our analysis suggest that obstetricians and midwives who work at Japanese hospitals take cooperative care of both low risk pregnant women and high risk women under complex and difficult working situations. For the future, we hope to identify effectiveness of these collaborations and make the better caring situation for both mothers and children.