College of Medicine, University of Vermont, Burlington, VT, USA.
Obstet Gynecol Surv. 2010 Feb;65(2):132-40. doi: 10.1097/OGX.0b013e3181d0fe5d.
A constant small, but clinically important, number of American women choose to deliver at home. Contradictory professional and public policies reflect the polarization and politicization of the controversy surrounding this birth option. Women opting for home birth seek and often attain their goals of a nonmedicalized experience in comfortable, familiar surroundings wherein they maintain situational control. However, home deliveries in developed Western nations are often associated with excess perinatal and neonatal mortality, particularly among nonanomalous term infants. On the other hand, current home birth practices are, especially when birth attendants are highly trained and fully integrated into comprehensive health care delivery systems, associated with fewer cesareans, operative vaginal deliveries, episiotomies, infections, and third and fourth degree lacerations. Newborn benefits include less meconium staining, assisted ventilation, low birth weight, prematurity, and intensive care admissions. Existing data suggest areas of future research regarding the safety of home birth in the United States.
Obstetricians & Gynecologists, Family Physicians.
After completion of this educational activity, the participant should be better able to assess perinatal outcomes described in the reported literature associated with home births in developed countries, list potential advantages and disadvantages of planned home births, and identify confounders in current literature that impact our thorough knowledge of home birth outcomes.
在美国，有一小部分女性（尽管数量始终不变，但她们的选择在临床上却具有重要意义）选择在家中分娩。围绕这种分娩选择的专业和公众政策相互矛盾，反映了两极分化和政治化的争议。选择在家分娩的女性寻求并经常实现了她们的目标，即在舒适、熟悉的环境中获得非医疗化的体验，并且能够掌控自己的处境。然而，在发达的西方国家，在家分娩通常与围产期和新生儿死亡率过高有关，尤其是在无异常的足月婴儿中。另一方面，目前的家庭分娩实践，特别是当分娩助手经过高度培训并完全融入综合医疗保健提供系统时，与较少的剖宫产、阴道手术分娩、会阴切开术、感染以及三度和四度裂伤有关。新生儿的益处包括胎粪污染减少、辅助通气、低出生体重、早产和重症监护入院减少。现有数据表明，美国家庭分娩安全性的未来研究领域存在一些问题。
妇产科医生、家庭医生。
完成本教育活动后，参与者应能够更好地评估报告文献中描述的与发达国家家庭分娩相关的围产期结局，列出计划在家分娩的潜在优点和缺点，并确定当前文献中影响我们对家庭分娩结局全面了解的混杂因素。
