丹麥孕產照護：助產師和產科醫師共同照護模式

Maternity care practice in Denmark: a model of collaboration between midwives and obstetricians

目標：助產師和產科醫生共同照護是目前許多先進國家採用的孕產照護模式。本文介紹施行該模式的北歐國家丹麥醫院裡，助產師與產科醫師專業分工的實作，並分析這套模式的優勢和其運作邏輯。方法：本文採用文獻分析，針對丹麥的全國統計資料庫、和相關文獻、報章媒體等整理和分析丹麥的孕產照護制度發展，並在丹麥進行田野調查，透過訪談（產科醫師、助產師和剛生產的懷孕女性）、參訪、診間的參與式觀察等，了解助產師和產科醫生分工下的照護實作以及挑戰。結果：丹麥孕產照護的專業分工來自國家制度化的保障，不但讓助產師和產科醫生能夠各司其職，亦能因應不同孕婦的健康需求給予照護。面對助產人力不足、居家產率上升等挑戰時，仍能從孕婦、助產師和產科醫師等多元角度去思考對策提出改善策略。結論：這些經驗有助於台灣相關政府單位未來想推動要學習這套孕產照護模式政策時作為參考。 Objectives: The shared care model between obstetricians and midwives is one of the most adopted maternity care models in advanced industrial countries. This article attempts to introduce the Danish maternity care system, which practices this model, to enrich our understanding of the practice in which a collaboration between obstetricians and midwives is practiced, and also to learn the advantages and logic of care embedded in its practice. Methods: To understand Danish maternity care practice, this article is based on data from the Danish media, the national database (Statistics Denmark), related articles and books, field work with interviews of obstetricians, midwives, and pregnant couples from 2014-2017, and participant observations in 7 hospitals in Denmark. Results: Danish law, which ensures a division of labor between obstetricians and midwives that enables midwifery and obstetric professionals to work following a model of collaboration that provides care according to a woman's need. The logic of the Danish maternity care means that when the system is facing challenges from a rising home birth rate and shortage of midwives, Danish society listens to different perspectives from obstetric and midwifery professionals and also to women's need when generating strategies to overcome those challenges. Conclusions: This model serves as a good example to the Taiwanese government and society, and it is therefore of value to learn the core value and care practice policy in this maternity care model.