Birth Models that Work (review)

Reviewed by: Birth Models that Work Marsden Wagner Birth Models That Work. Robbie Davis-Floyd, Lesley Barclay, Betty-Anne Daviss, and Jan Tritten. Berkeley: Univ. of California Press, 2009. Pp. 496 $27.50 (paper). Today in the United States, one third of all pregnant women do not give birth: their babies are cut out by an obstetrician/surgeon through major abdominal surgery—cesarean section. This means that of the 4 million births every year, there are over 1.2 million cesarean sections. The reported maternal mortality rate for the United States is 15 per 100,000 births (the actual rate is unquestionably higher). Since the maternal mortality for cesarean section is over double that for vaginal birth (Hall and Bewley 1999), 240 or 46% of the 520 annual reported maternal deaths are associated with cesarean section. No wonder the U. S. maternal mortality rate is higher than in over 30 other countries. [End Page 642] But if the U. S. cesarean section rate were 15%—the highest acceptable rate according to WHO and the best scientific evidence (Betrán et al. 2007)—there would be half as many cesarean sections annually and 460 maternal deaths rather than 520: 60 fewer deaths. Thus the present rate of cesarean births in the United States means a minimum of 600,000 unnecessary cesareans a year (over 1,640 unnecessary every day), leading to a minimum of 60 excessive, unnecessary maternal deaths a year (over one unnecessary death every week). How did we get to this tragic state of affairs in the United States? As I lay out in detail in my recent book Born in the USA: How a Broken Maternity System Must Be Fixed to put Women and Children First (Wagner 2008), it is not because we have bad health professionals—they are excellent—but because of a bizarre maternity care system not found anywhere else in the world, where surgeons (obstetricians) insist on managing normal (low-risk) birth. Everywhere else it is midwives who attend normal birth. How do we get out of this maternity mess? Are there better, safer, cheaper ways of managing childbirth? There are forces at work in the United States to prevent any change in the present obstetric-lead, hospital-based model, which is the greatest source of income for obstetricians and hospitals. These forces claim, without any evidence, that changes would be dangerous, unsafe, and expensive. Here is where this new book—Birth Models That Work, edited by Davis-Floyd, et al.—is of enormous value. All of the models presented in this volume are ideologically and practically based on the midwifery (humanistic/holistic) model of care and can be adopted and applied by any and all birth practitioners. The models have been working for some time and have all been proven to be safe, to improve the physiological, psychological, and social outcomes of pregnancy and birth, and to save money for systems and families. The birth models that work are broken into four section in the book: • large-scale systems, including the Netherlands, New Zealand, Ontario, Canada, and Samoa; • local models in developed countries, including two U. S. midwifery practices, a freestanding birth center in England, a transformed hospital maternity service in Australia, and maternity homes in Japan; • models in developing countries, including an obstetric practice using midwives and Doulas in Brazil, a school of midwifery in Mexico, and two out-of-hospital birth centers in the Philippines; • a final section on making models work, using examples from the United States and Brazil. Birth Models That Work is a major contribution to the global struggle for control of women's bodies and their giving birth, and it should be read by all obstetricians, midwives, obstetric nurses, pregnant women, and anyone else with interest in maternity care. It documents the worldwide success of programs for [End Page 643] pregnancy and birth that honor the women and put them in the center and in control of their own reproductive lives. The book concludes: Birth models that work—expose the need for the total reform of existing dysfunctional, hegemonic models. They issue a clarion call to global health organizations, non-governmental organizations, and individuals to replace birth models...

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