School of Nursing, Yale University, West Haven, CT, USA.
School of Community Health and Midwifery, Research in Childbirth and Health Unit (REACH) Group, University of Central Lancashire, Lancashire, UK.
Birth. 2020 Dec;47(4):332-345. doi: 10.1111/birt.12504. Epub 2020 Oct 30.
The United States (US) spends more on health care than any other high-resource country. Despite this, their maternal and newborn outcomes are worse than all other countries with similar levels of economic development. Our purpose was to describe maternal and newborn outcomes and organization of care in four high-resource countries (Australia, Canada, the Netherlands, and United Kingdom) with consistently better outcomes and lower health care costs, and to identify opportunities for emulation and improvement in the United States.
We examined resources that described health care organization and financing, provider types, birth settings, national, clinical guidelines, health care policies, surveillance data, and information for consumers. We conducted interviews with country stakeholders representing the disciplines of obstetrics, midwifery, pediatrics, neonatology, epidemiology, sociology, political science, public health, and health services. The results of the analysis were compared and contrasted with the US maternity system.
The four countries had lower rates of maternal mortality, low birthweight, and newborn and infant death than the United States. Five commonalities were identified as follows: (1) affordable/ accessible health care, (2) a maternity workforce that emphasized midwifery care and interprofessional collaboration, (3) respectful care and maternal autonomy, (4) evidence-based guidelines on place of birth, and (5) national data collections systems.
The findings reveal marked differences in the other countries compared to the United States. It is critical to consider the evidence for improved maternal and newborn outcomes with different models of care and to examine US cultural and structural failures that are leading to unacceptable and substandard maternal and infant outcomes.
美国在医疗保健方面的支出高于任何其他高资源国家，但美国的母婴结局却比所有其他经济发展水平相似的国家都要差。我们的目的是描述澳大利亚、加拿大、荷兰和英国这四个资源丰富、母婴结局更好且医疗保健成本更低的国家的母婴结局和护理组织情况，并确定美国可以借鉴和改进的机会。
我们研究了描述医疗保健组织和融资、提供者类型、分娩场所、国家、临床指南、医疗保健政策、监测数据以及消费者信息的资源。我们采访了来自妇产科、助产、儿科、新生儿科、流行病学、社会学、政治学、公共卫生和卫生服务等学科的国家利益相关者。分析结果与美国的产妇系统进行了比较和对比。
这四个国家的孕产妇死亡率、低出生体重儿以及新生儿和婴儿死亡率均低于美国。确定了以下五个共同点：（1）负担得起/可获得的医疗保健；（2）强调助产护理和跨专业合作的产妇劳动力；（3）尊重护理和产妇自主权；（4）关于分娩地点的循证指南；（5）国家数据收集系统。
这些发现揭示了其他国家与美国之间的明显差异。必须考虑不同护理模式下改善母婴结局的证据，并研究导致不可接受和低标准母婴结局的美国文化和结构失败。
