Birth Models That Work

For years birth activists have been saying it: “that doesn’t work, it just doesn’t work.” By “doesn’t work,” they mean the contemporary obstetrical treatment of birth around the world. It doesn’t work. Yes, babies get born and lives that could have been lost get saved through modern obstetrics, but the price in both money and collateral damage to mother and baby is increasingly high. This price shouldn’t have to be paid, because it is based on misinformation and misunderstanding of the normal physiology of birth and how to best support it. It comes from a system that seeks to avoid mortality through the excess application of interventions while failing to recognize that those very interventions when overused cause unnecessary morbidity – and increasingly, even mortality itself –to the mother or baby. Intervention is now associated with increased maternal and perinatal mortality figures due in part to the excess use of cesarean section in many countries; the increased rate of cesareans has become the unwitting accomplice to the mortality this operation is designed to avoid (see below)

As the models described in this volume demonstrate, it is not necessary to “trade off” the morbidity associated with interventions for avoidance mortality – decreasing intervention and increasing support of normal physiological birth both serve to avoid mortality. Indeed, as we will show in these pages, some low-intervention models of birth can demonstrate lower morbidity and equivalent (or lower) mortality than high-intervention tertiary care.

Birth Models That Work

First and foremost, models that work do not cause unnecessary harm to mothers and babies. Each chapter presents a case study of one model that works and describes the impetus for this model’s development, the process through which it was developed, its underlying philosophy, and its specific characteristics…

The models include:

• Large-scale national systems (the Netherlands, New Zealand, Ontario, Samoa(where social and professional midwives work together)

• Local Models in Developed nations e.g. The Albany Midwifery Practice (Britain), a birth centre in England, Japan, Australia, New Mexico…

• Local Models in Developing Nations (traditional, professional, and obstetrics working together…

• Making Models Work, e.g. Centering Pregnancy@ Group Prenatal Care, Humanizing Childbirth in Brazil