Goodman Steffie
Department of Ob Gyn, Division of Reproductive Science, School of Medicine, University of Colorado at Denver and Health Sciences Center, PO Box 6511, Campus Box 8309, 80045 Aurora, CO, USA.
Soc Sci Med. 2007 Aug;65(3):610-21. doi: 10.1016/j.socscimed.2007.03.052. Epub 2007 May 1.
This paper investigates the marginalization of certified nurse-midwives (CNMs) in the US. This marginalization occurs despite ample evidence demonstrating that a midwifery model delivers high-quality cost-effective care. Currently midwives attend only 7% of births, compared to 50-75% of births in other developed countries. Given the escalating costs of health care and relatively poor maternal and child health indicators in comparison with other developed countries, these findings are disturbing. This paper investigates this paradox through a qualitative case study of two prestigious but declining midwifery services in a large US city. Fifty-two multi-sited in-depth interviews were conducted along with an analysis of relevant archival sources. It was found that institutions successfully altered maternity care and diminished midwifery services without accountability for their actions. These findings illuminate the larger political-economic forces that shape the marginalization of midwifery in the US.
本文探讨了美国注册护士助产士（CNM）的边缘化问题。尽管有充分证据表明助产模式能提供高质量、高性价比的护理服务，但这种边缘化现象仍在发生。目前，助产士仅参与7%的分娩，而在其他发达国家，这一比例为50%-75%。鉴于医疗保健成本不断攀升，且与其他发达国家相比，母婴健康指标相对较差，这些发现令人不安。本文通过对美国一个大城市中两家享有盛誉但日渐式微的助产服务机构进行定性案例研究，来探究这一矛盾现象。研究人员进行了52次多地点深度访谈，并对相关档案资料进行了分析。研究发现，一些机构成功改变了产妇护理方式并减少了助产服务，却无需对其行为负责。这些发现揭示了塑造美国助产士边缘化现象的更大的政治经济力量。
