Langton P A
Sociology Department, George Washington University, Washington, DC 20052.
Women Health. 1994;22(1):27-48. doi: 10.1300/J013v22n01_03.
This paper examines obstetricians' explanations for the longstanding and current conflict between obstetricians and nurse-midwives in the District of Columbia over the struggle for independent practice for nurse-midwives. Based on extended interviews with obstetricians, this study shows they are reluctant to provide nurse-midwives with medical backup, a requirement of D.C. law for nurse-midwives to deliver babies in District hospitals. Obstetricians' concerns involve the boundaries of professional responsibility, and economic constraints. Obstetricians believe their more extensive training better qualifies them to handle difficult pregnancies, and they are concerned that nurse-midwives may not call for their help when it is needed. They argue that expanding the use of nurse-midwives will lead to a competition for healthy clients, a competition for paying clients, increased exposure to malpractice liability for obstetricians providing backup, and difficulty obtaining reimbursement from nurse-midwives for their services.
本文探讨了产科医生对哥伦比亚特区产科医生与助产士之间长期存在且当前仍在持续的冲突的解释，该冲突围绕助产士争取独立执业的斗争展开。基于对产科医生的深入访谈，本研究表明，他们不愿为助产士提供医疗支持，而这是特区法律规定助产士在特区医院接生的一项要求。产科医生的担忧涉及专业责任的界限和经济限制。产科医生认为他们更广泛的培训使他们更有资格处理困难的妊娠情况，并且他们担心助产士在需要时可能不会寻求他们的帮助。他们认为扩大助产士的使用将导致对健康客户的竞争、对付费客户的竞争、为助产士提供支持的产科医生面临的医疗事故责任风险增加，以及从助产士那里获得服务费用报销的困难。
