Dickinson C P, Jackson D J, Swartz W H
UCSD School of Medicine.
J Nurse Midwifery. 1994 Mar-Apr;39(2):112-8. doi: 10.1016/0091-2182(94)90020-5.
The BirthPlace program in San Diego, California, is an example of a successfully "mainstreamed" alternative maternity care program. It was developed to address an access to prenatal care problem in the county, and it has successfully integrated four systems of care: 1) a private practice of nurse-midwives and obstetricians, 2) the public community clinic system, 3) the tertiary university hospital, and 4) a freestanding birth center. It provides a model of care that, if replicated, could be an answer for ensuring universal access to maternity care in the United States. The BirthPlace program primarily serves a public-funded, Hispanic population, with certified nurse-midwives as the primary providers. The program's greatest challenge has been to maintain a personalized, family-centered focus, which has been the hallmark of freestanding birth centers to date, in the face of large numbers of clients and low reimbursement for care. The program has addressed the challenge of increasing access and cost-effectiveness while ensuring family-centered care through decentralized clinic management, informed consent, culturally sensitive care, and appropriate use of technology. However, in the face of an ever-changing health care system, balancing these issues will remain a constant challenge as we reshape our maternity care services.
加利福尼亚州圣地亚哥的“出生地”项目是一个成功实现“主流化”的替代性孕产妇护理项目的典范。该项目旨在解决该县产前护理服务获取问题，并且成功整合了四个护理系统：1）由护士助产士和产科医生组成的私人诊所；2）公共社区诊所系统；3）三级大学医院；4）独立的分娩中心。它提供了一种护理模式，若能得以推广，有望成为确保美国普及孕产妇护理服务的解决方案。“出生地”项目主要服务于由公共资金资助的西班牙裔人群，由持证护士助产士作为主要护理提供者。该项目面临的最大挑战一直是，在面对大量客户以及护理报销费用较低的情况下，仍要保持个性化、以家庭为中心的服务重点，而这一直是独立分娩中心的特色。该项目通过分散式诊所管理、知情同意、文化敏感护理以及合理使用技术，在确保以家庭为中心的护理的同时，应对了增加服务可及性和成本效益的挑战。然而，面对不断变化的医疗保健系统，在重塑我们的孕产妇护理服务时，平衡这些问题仍将是一项持续的挑战。
