Declercq E
Boston University, USA.
J Health Polit Policy Law. 1998 Oct;23(5):833-59. doi: 10.1215/03616878-23-5-833.
This article examines the process that led to the "changing childbirth" initiative in the United Kingdom and its possible lessons for U.S. health policy making. Changing childbirth involves substantial changes in maternity care policy, including increased independence for midwives; greater choice for mothers of birthplace and attendant; and a narrower, more specialized role for obstetricians. Potential lessons for U.S. health policy include the following points: Even narrow, targeted reform is generally slow to develop, and bureaucracies continue to show ingenuity in delaying their response to initiatives; systematic research and control over problem definition powerfully shapes the policy debate (in the United Kingdom the debate focused on normal birth, rather than on the traditional inquiry into perinatal death); a few well-placed individuals (e.g., female legislators) can bring maternity care issues to the policy agenda; and politically skilled consumer groups (which in the case of maternity care essentially do not exist in the United States) can influence the process.
本文探讨了英国“变革分娩”倡议的形成过程及其对美国卫生政策制定可能产生的借鉴意义。变革分娩涉及产妇护理政策的重大变革，包括助产士独立性增强；母亲对分娩地点和护理人员有更多选择；产科医生的角色更窄、更专业化。对美国卫生政策的潜在借鉴意义包括以下几点：即使是范围狭窄、目标明确的改革通常也进展缓慢，官僚机构在拖延对倡议的回应方面仍表现出足智多谋；对问题定义进行系统研究并加以控制会有力地影响政策辩论（在英国，辩论聚焦于正常分娩，而非传统的围产期死亡调查）；一些关键人物（如女性立法者）能够将产妇护理问题提上政策议程；以及具备政治技巧的消费者团体（在美国，产妇护理领域基本不存在此类团体）能够影响这一进程。
