Midwifery and Childbirth in America

Childbirth is both a profound experience and a contested subject. The experience of women has complex medical, historical, cultural, and public policy dimensions. In this book, Judith Rooks achieves the rare feat of bringing these dimensions together in a way that can be appreciated by health care planners, midwives, physicians, and women considering pregnancy. The author vividly describes the history of struggle among health care providers over the meaning and handling of the birth process. The medical model and the midwifery model continue to collide today, the former focusing on pathology and monitoring the patient for it, the latter focusing on birth as a normal, healthy process. The education and professional training of those who care for women during pregnancy, childbirth, and the important postpartum period reflects these divisions. Obstetrics, family physicians, midwives, nurses, and others play roles in providing the necessary care. In focusing on midwives, Rooks deals fairly and sensitively between certified nurse-midwives and direct-entry midwives, most of whom lack formal educational preparation in midwifery. This book describes clearly and with documented scientific evidence the specific benefits of the midwifery approach to the care of pregnant women and their families. In clear language accessible to the lay reader, Rooks summarizes the research on the unintended effects of obstetrical interventions, such as episiotomies, epidurals, C-sections, and continuous electronic fetal heart monitoring, and the effectiveness and important benefits of an approach that focuses on the positive potential of childbearing, as contrasted with a narrow focus of potential for pathology. While she acknowledges the importance of access to medical care, extensive research shows the advantages of the midwifery approach. Much that passes for \u0022routine\u0022 obstetric care in the United States has been found to be unnecessary, ineffective, or even harmful when applied to women with normal pregnancies. The arguments over the control of childbirth are set in the context of recent changes in health care, including the current transition to managed care; the impact of the women's movement and movements for natural childbirth, home birth, and breastfeeding; and women's fear of and concern about the pain associated with labor. Rooks also explains the influence of the reports and recommendations of prestigious scientific and health-policy commissions and of federal initiatives and programs on the care provided to pregnant women in this country. She contrasts U.S. practices with those of comparable industrialized countries like the European states, Canada, Australia, New Zealand, and Japan.