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，有床位的产科诊所必须指定一名签约产科医生和一家签约医院，协助处理紧急情况和/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自己的产科诊所的经验。参与者包括23名在2003年至2009年期间开设产科诊所的助产士。数据收集采用半结构化访谈从2007年到2009年。本研究由日本红十字会护理伦理委员会批准，23名助产士中有12名设立了有床位的产科诊所，11名助产士设立了没有床位的产科诊所。处理家庭分娩的助产士有一个设施，但她在那里为怀孕和母乳喂养咨询提供健康指导。几乎所有的助产士都提供从怀孕到产后的连续性护理。此外，助产士通常会雇佣1到2名额外的助产士来帮助分娩。助产士每年接生1-80个婴儿。所有23个参与者都指定了合同医院，但签署的协议条件差别很大。一些医院要求妇女在怀孕期间必须到医院进行2-3次健康检查，将所有健康检查和分娩主要交给助产士。在某些情况下，医院不会签署任何正式合同，而只是给出口头协议。只上门和计划在家分娩的助产士不需要指定签约的产科医生，因此许多人不这样做。然而，如果妇女自己希望这样做，可以请一位“合作产科医生”，这位产科医生只会支持那位妇女。助产士普遍同意这一点，而终身助产士也毫不费力地找到了产科医生来支持她的女性。然而，农村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