Rainey Emily, Simonsen Sara, Stanford Joseph, Shoaf Kimberley, Baayd Jami
Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT, USA.
University of Utah College of Nursing, Salt Lake City, UT, USA.
Birth. 2017 Jun;44(2):137-144. doi: 10.1111/birt.12276. Epub 2017 Feb 17.
The United Kingdom's National Institute for Health and Care Excellence (NICE) recently published recommendations that support planned home birth for low-risk women. The American College of Obstetricians and Gynecologists (ACOG) remains wary of planned home birth, asserting that hospitals and birthing centers are the safest birth settings. Our objective was to examine opinions of obstetricians in Salt Lake City, Utah about home birth in the context of rising home birth rates and conflicting guidelines.
Participants were recruited through online searches of Salt Lake City obstetricians and through snowball sampling. We conducted individual interviews exploring experiences with and attitudes toward planned home birth and the ACOG/NICE guidelines.
Fifteen obstetricians who varied according to years of experience, location of medical training, sex, and subspecialty (resident, OB/GYN, maternal-fetal medicine specialist) were interviewed. Participants did not recommend home birth but supported a woman's right to choose her birth setting. Obstetrician opinions about planned home birth were shaped by misconceptions of home birth benefits, confusion surrounding the scope of care at home and among home birth providers, and negative transfer experiences. Participants were unfamiliar with the literature on planned home birth and/or viewed the evidence as unreliable. Support for ACOG guidelines was high, particularly in the context of the United States health care setting.
Physician objectivity may be limited by biases against home birth, which stem from limited familiarity with published evidence, negative experiences with home-to-hospital transfers, and distrust of home birth providers in a health care system not designed to support home birth.
英国国家卫生与临床优化研究所（NICE）最近发布了支持低风险女性计划在家分娩的建议。美国妇产科医师学会（ACOG）对计划在家分娩仍持谨慎态度，坚称医院和分娩中心是最安全的分娩场所。我们的目的是在家庭分娩率上升和指南相互冲突的背景下，调查犹他州盐湖城产科医生对家庭分娩的看法。
通过对盐湖城产科医生的在线搜索和滚雪球抽样招募参与者。我们进行了个人访谈，探讨他们对计划在家分娩的经历和态度以及ACOG/NICE指南。
采访了15名产科医生，他们在经验年限、医学培训地点、性别和亚专业（住院医师、妇产科医生、母胎医学专家）方面各不相同。参与者不推荐在家分娩，但支持女性选择分娩场所的权利。产科医生对计划在家分娩的看法受到对家庭分娩益处的误解、对家庭及家庭分娩提供者护理范围的困惑以及负面转诊经历的影响。参与者不熟悉关于计划在家分娩的文献，和/或将证据视为不可靠。对ACOG指南的支持度很高，尤其是在美国医疗环境背景下。
医生的客观性可能受到对家庭分娩偏见的限制，这种偏见源于对已发表证据的熟悉程度有限、家庭转院的负面经历以及在一个并非为支持家庭分娩而设计的医疗系统中对家庭分娩提供者的不信任。
