De Vries Raymond, Nieuwenhuijze Marianne, Buitendijk Simone E
Faculty of Midwifery Education & Studies, Zuyd University, Maastricht, Netherlands; CAPHRI, School for Public Health and Primary Care, Maastricht University, Netherlands; Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Midwifery. 2013 Oct;29(10):1122-8. doi: 10.1016/j.midw.2013.07.007. Epub 2013 Aug 2.
In the 1970s, advocates of demedicalising pregnancy and birth 'discovered' Dutch maternity care. The Netherlands presented an attractive model because its maternity care system was characterised by a strong and independent profession of midwifery, close co-operation between obstetricians and midwives, a very high rate of births at home, little use of caesarean section, and morbidity and mortality statistics that were among the best in the developed world. Over the course of the following 40 years much has changed in the Netherlands. Although the home birth rate remains quite high when compared to other modern countries, it is half of what it was in the 1970s. Midwifery is still an independent medical profession, but a move toward 'integrated care' threatens to bring midwives into hospitals under the direction of medical specialists, more women are interested in medical pain relief, and there is a growing concern that current, albeit slight, increases in rates of intervention in physiological births foreshadow the end of the unique approach to birth in the Netherlands. The story of Dutch maternity care thus offers an ideal opportunity to examine the social, organisational, and cultural factors that work to support, and to diminish, the independent practice of midwifery in high-resource countries. We may wish to believe that providing ample and convincing evidence of the value of midwifery care will be enough to promote more and better use of midwifery, but the lessons from the Netherlands make clear that an array of social forces play a critical role determining the place of midwives in the health care system and how the care they provide is deployed.
20世纪70年代，主张将怀孕和分娩去医学化的倡导者“发现”了荷兰的孕产妇护理模式。荷兰提供了一个有吸引力的模式，因为其孕产妇护理系统的特点是有强大且独立的助产士职业、产科医生和助产士之间密切合作、在家分娩的比例非常高、很少使用剖宫产，以及发病率和死亡率统计数据在发达国家中名列前茅。在接下来的40年里，荷兰发生了很大变化。尽管与其他现代国家相比，荷兰的在家分娩率仍然相当高，但只是20世纪70年代的一半。助产士仍然是一个独立的医学专业，但向“综合护理”的转变有可能使助产士在医学专家的指导下进入医院，更多女性对医学止痛方法感兴趣，而且人们越来越担心，目前尽管生理分娩干预率略有上升，但这预示着荷兰独特的分娩方式即将结束。因此，荷兰孕产妇护理的故事为研究在资源丰富的国家中支持和削弱助产士独立执业的社会、组织和文化因素提供了一个理想的机会。我们可能希望相信，提供充分且有说服力的助产护理价值证据就足以促进更多更好地利用助产服务，但荷兰的经验清楚地表明，一系列社会力量在决定助产士在医疗保健系统中的地位以及她们所提供的护理如何被利用方面起着关键作用。
