わが国における"Care in normal birth: a practical guide"の実態 : 病院と有床診療所の調査 : 助産師数からみた検討  [in Japanese] The reality of practicing "care in normal birth: a practical guide" in Japan : A study of hospitals and clinics with beds from a perspective of the number of midwives  [in Japanese]

本研究は,病院と診療所の妊産婦ケアの実施状況とそこに勤務する常勤助産師の割合をWHOの"Care in normal birth: a practical guide"の実態調査を基に検討した。対象は全国の産科を有する診療所323施設と病院617施設である。調査内容はWHOが提言している妊産婦ケア59項目,回答形式は「全例実施」「ケースによって実施」「実施しない」の3段階評定法とした。WHOでは,ケアの内容をA:明らかに有効で役立つ推奨されるべきこと,B:明らかに害があったり効果がないのでやめるべきこと,C:十分な証拠がないのでまだはっきりと勧めることができないこと,D:しばしば不適切に使われたり不適切に実施されることの4カテゴリーに分類している。結果として以下のことが明らかとなった。1)カテゴリーAの項目で,「全例実施」している施設の常勤助産師割合が有意に高かった項目は病院で3項目,診療所で6項目みられた。2)カテゴリーBの項目では,常勤助産師割合が有意に高かった項目は病院では3項目であった。以上から,カテゴリーA・Bともに常勤助産師が多くいるほど望ましいケアを実施していることが示唆された。

In this study we examined the reality of maternal care in hospitals and clinics as well as the number of full-time midwives working there based on the research reported in the WHO's "Care in normal birth: a practical guide." A questionnaire method was used with 323 clinics and 617 hospitals with obstetric departments in Japan. The items used in the questionnaire included the 59 items of maternal care as advocated by WHO. The response was made on a 3-point scale of "complete implementation," "partial implementation" and "no implementation." The WHO categorizes the care contents into four groups- (A): "That which is clearly useful and effective," (B): "That which is clearly harmful and useless and thus should be abandoned," (C): "That which cannot be recommended due to lack of sufficient evidence," and (D): "That which is often used or implemented improperly." As a result, we obtained the following findings: (1) In terms of the items under Category (A), 3 of the items for the hospitals and 6 of the items for the clinics had a significantly high proportion of full-time midwives who were completely implementing them; (2) In terms of the items under Category (B), 3 of the items for the hospitals had a significantly high proportion of full-time midwives. In conclusion, it was implied that institutions with a high proportion of full-time midwives provided more desirable care in terms of both Categories (A) and (B).