Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, and the Department of Anthropology, Oregon State University, Corvallis, Oregon.
Obstet Gynecol. 2019 May;133(5):1033-1050. doi: 10.1097/AOG.0000000000003215.
There has been a small, but significant, increase in community births (home and birth-center births) in the United States in recent years. The rate increased by 20% from 2004 to 2008, and another 59% from 2008 to 2012, though the overall rate is still low at less than 2%. Although the United States is not the only country with a large majority of births occurring in the hospital, there are other high-resource countries where home and birth-center birth are far more common and where community midwives (those attending births at home and in birth centers) are far more central to the provision of care. In many such countries, the differences in perinatal outcomes between hospital and community births are small, and there are lower rates of maternal morbidity in the community setting. In the United States, perinatal mortality appears to be higher for community births, though there has yet to be a national study comparing outcomes across settings that controls for planned place of birth. Rates of intervention, including cesarean delivery, are significantly higher in hospital births in the United States. Compared with the United States, countries that have higher rates of community births have better integrated systems with clearer national guidelines governing risk criteria and planned birth location, as well as transfer to higher levels of care. Differences in outcomes, systems, approaches, and client motivations are important to understand, because they are critical to the processes of person-centered care and to risk reduction across all birth settings.
近年来，美国社区分娩（家庭和生育中心分娩）的数量略有增加，但意义重大。从 2004 年到 2008 年，这一比例增加了 20%，从 2008 年到 2012 年又增加了 59%，尽管总体比例仍低于 2%。虽然美国不是唯一一个大多数分娩都在医院进行的国家，但也有其他高资源国家，在这些国家，家庭和生育中心的分娩更为常见，社区助产士（在家庭和生育中心接生的助产士）在提供护理方面更为核心。在许多这样的国家，医院分娩和社区分娩的围产期结局差异较小，社区环境中的产妇发病率也较低。在美国，社区分娩的围产儿死亡率似乎更高，尽管尚未有全国性研究对不同环境下的结局进行比较，并对计划分娩地点进行控制。在美国，医院分娩的干预率（包括剖腹产）明显更高。与美国相比，社区分娩率较高的国家拥有更完善的系统，更明确的国家指导方针，规定了风险标准和计划分娩地点，以及向更高水平的护理的转移。了解结局、系统、方法和客户动机方面的差异非常重要，因为这些差异是在所有分娩环境中实现以人为本的护理和降低风险过程的关键。
