Division of Midwifery, Department of Family Practice, University of British Columbia, Canada.
Midwifery. 2012 Oct;28(5):600-8. doi: 10.1016/j.midw.2012.06.011. Epub 2012 Aug 25.
(1) to describe educational, practice, and personal experiences related to home birth practice among Canadian obstetricians, family physicians, and registered midwives; (2) to identify barriers to provision of planned home birth services, and (3) to examine inter-professional differences in attitudes towards planned home birth.
the first phase of a mixed-methods study, a quantitative survey, comprised of 38 items eliciting demographic, education and practice data, and 48 items about attitudes towards planned home birth, was distributed electronically to all registered midwives (N=759) and obstetricians who provide maternity care (N=800), and a random sample of family physicians (n=3,000).
Canada. This national investigation was funded by the Canadian Institutes for Health Research.
Canadian registered midwives (n=451), obstetricians (n=245), and family physicians (n=139).
almost all registered midwives had extensive educational and practice experiences with planned home birth, and most obstetricians and family physicians had minimal exposure. Attitudes among midwives and physicians towards home birth safety and advisability were significantly different. Physicians believed that home births are less safe than hospital births, while midwives did not agree. Both groups believed that their views were evidence-based. Midwives were the most comfortable with including planned home birth as an option when discussing choice of birth place with pregnant women. Both midwives and physicians expressed discomfort with inter-professional consultation related to planned home births. In addition, both family physicians and obstetricians reported discomfort with discussing home birth with their patients. A significant proportion of family physicians and obstetricians would have liked to attend a home birth as part of their education.
the amount and type of education and exposure to planned home birth practice among maternity care providers were associated with attitudes towards home birth, comfort with discussing birth place options with women, and beliefs about safety. Barriers to home birth practice across professions were both logistical and philosophical.
formal mechanisms for midwifery and medical education programs to increase exposure to the theory and practice of planned home birth may facilitate evidence based informed choice of birth place, and increase comfort with integration of care across birth settings. An increased focus among learners and clinicians on reliable methods for assessing the quality of the evidence about birth place and maternal-newborn outcomes may be beneficial.
（1）描述加拿大产科医生、家庭医生和注册助产士在家庭分娩实践方面的教育、实践和个人经验；（2）确定提供计划家庭分娩服务的障碍；（3）研究专业间对计划家庭分娩态度的差异。
这是一项混合方法研究的第一阶段，采用电子方式向所有注册助产士（N=759）和提供产科护理的产科医生（N=800）以及家庭医生的随机样本（n=3000）分发了一项包括 38 个项目的定量调查，这些项目引出了人口统计学、教育和实践数据，以及 48 个关于对计划家庭分娩的态度的项目。
加拿大。该国家调查由加拿大卫生研究院资助。
加拿大注册助产士（n=451）、产科医生（n=245）和家庭医生（n=139）。
几乎所有的注册助产士都有广泛的计划家庭分娩教育和实践经验，而大多数产科医生和家庭医生则接触甚少。助产士和医生对家庭分娩安全性和适宜性的态度有显著差异。医生认为家庭分娩不如医院分娩安全，而助产士则不同意。两组都认为他们的观点是基于证据的。当与孕妇讨论分娩地点的选择时，助产士最愿意将计划家庭分娩作为一种选择。助产士和医生都对计划家庭分娩的专业间咨询表示不适。此外，家庭医生和产科医生都表示对与患者讨论家庭分娩感到不适。相当一部分家庭医生和产科医生希望参加家庭分娩作为他们教育的一部分。
提供产科护理的人员接受的教育的数量和类型以及对计划家庭分娩实践的接触程度与对家庭分娩的态度、与妇女讨论分娩地点选择的舒适度以及对安全性的信念有关。专业间家庭分娩实践的障碍既有实际的，也有哲学上的。为助产士和医学教育计划建立正式机制，增加对计划家庭分娩理论和实践的了解，可能有助于在知情的情况下选择分娩地点，并增加在分娩环境中整合护理的舒适度。学习者和临床医生更加关注评估分娩地点和母婴结局质量的可靠方法，可能会有所裨益。
