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 u0022routineu0022 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.
"...clear, articulate, and well-researched work... [It] is a treasure trove of information and resources to everyone who works in the maternity services, to policy-makers, and to women. No library or bookshelf should be without it. This scholarly treatise is the most exhaustive, balanced, and comprehensive book on midwifery that has been written, and it will serve as an impetus and inspiration to a broad audience." - Birth "We have been waiting a long time for this book: a comprehensive, readable, and authoritative discussion of the important role of midwifery in the United States. It will spark a passionate - and long overdue - dialogue about the way pregnant women are taken care of in this country." - Roger A. Rosenblatt, MD, MPH, Professor and Vice Chair of the Department of Family Medicine, University of Washington, Seattle "Rooks has written a comprehensive, balanced and eminently readable book." - The Journal of the Association for Research on Mothering
List of Tables Foreword Charles S. Mahan, M.D. Preface Acknowledgments 1. What Is Midwifery? 2. Brief History of Midwifery in the West 3. The Beginning of Nurse-Midwifery 4. Midwifery Amid the Social Movements of the 1960s and 1970s 5. Maternal and Infant Health and the Health Care System, 1980-1995 6. Midwifery in America: Philosophy, Objectives, and Body of Knowledge 7. Midwifery in America, 1980-1994: Percent of Births, Place of Birth, and Clientele 8. Nurse-Midwifery in America, 1980-1995 9. Development of Direct-Entry Midwifery, 1980-1995 10. The Quality, Safety, and Effectiveness of Midwifery as Practiced in the United States 11. Safety of Out-of-Hospital Births in the United States 12. Effects of Midwifery Care on Costs and Other Special Contributions 13. Midwifery in Europe, Canada, Australia, New Zealand, and Japan 14. The Current Situation and Recommendations for the Future References Index