Wiegers T A, van der Zee J, Keirse M J
The Netherlands Institute of Primary Health Care, Utrecht, The Netherlands.
Birth. 1998 Sep;25(3):190-7. doi: 10.1046/j.1523-536x.1998.00190.x.
In 1965 two-thirds of all births in The Netherlands occurred at home. In the next 25 years, that situation became reversed with more than two-thirds of births occurring in hospital and fewer than one-third at home. Several factors have influenced that change, including the introduction of short-stay hospital birth, hospital facilities for independent midwives, increased referral rates from primary to secondary care, changes in the share of the different professionals involved in maternity care, medical technology, and demographic changes. After a decline up to 1978 and a period of relative stability between 1978 and 1988, the home birth rate started to decline further, to the extent that it might destabilize the Dutch maternity care system and the role of midwives in it. The Dutch maternity care system depends heavily on primary caregivers, midwives and general practitioners who are responsible for the care of women with low-risk pregnancies, and on obstetricians who provide care for high-risk pregnancies. Its preservation requires a high level of cooperation among the different caregivers, and a functional selection system to ensure that all women receive the type of care that is best suited to their needs. Preserving the home birth option in the Dutch maternity care system necessitates the maintenance of high training and postgraduate standards for midwives, the continued provision of maternity home care assistants, and giving women with uncomplicated pregnancies enough confidence in themselves and the system to feel safe in choosing a home birth.
1965年，荷兰三分之二的分娩在家中进行。在接下来的25年里，这种情况发生了逆转，超过三分之二的分娩在医院进行，在家中分娩的比例不到三分之一。有几个因素影响了这一变化，包括短期住院分娩的引入、为独立助产士提供的医院设施、从初级保健向二级保健转诊率的增加、参与孕产妇护理的不同专业人员比例的变化、医疗技术以及人口结构的变化。在1978年之前出生率下降以及1978年至1988年期间相对稳定之后，家庭分娩率开始进一步下降，以至于可能会破坏荷兰孕产妇护理系统以及助产士在其中的作用。荷兰的孕产妇护理系统严重依赖负责照顾低风险孕妇的初级护理人员、助产士和全科医生，以及为高风险孕妇提供护理的产科医生。其维持需要不同护理人员之间高度的合作，以及一个有效的选择系统，以确保所有妇女都能获得最适合其需求的护理类型。在荷兰孕产妇护理系统中保留家庭分娩选项需要维持助产士的高培训和研究生标准，持续提供孕产妇家庭护理助理，并让怀孕情况不复杂的妇女对自己和该系统有足够的信心，从而放心选择家庭分娩。
