Seeking an alternative baseline for birth.

Birth is a spiritual experience for mother and baby. Women need information and psychological preparation before birth, and a knowledgeable companion during birth. Unless medical intervention is needed, medical personnel should step back and stay out of the way.

Planned home birth in the United States and professionalism: a critical assessment.

Planned home birth has been considered by some to be consistent with professional responsibility in patient care. This article critically assesses the ethical and scientific justification for this view and shows it to be unjustified. We critically assess recent statements by professional associations of obstetricians, one that sanctions and one that endorses planned home birth. We base our critical appraisal on the professional responsibility model of obstetric ethics, which is based on the ethical concept of medicine from the Scottish and English Enlightenments of the 18th century. Our critical assessment supports the following conclusions. Because of its significantly increased, preventable perinatal risks, planned home birth in the United States is not clinically or ethically benign. Attending planned home birth, no matter one's training or experience, is not acting in a professional capacity, because this role preventably results in clinically unnecessary and therefore clinically unacceptable perinatal risk. It is therefore not consistent with the ethical concept of medicine as a profession for any attendant to planned home birth to represent himself or herself as a "professional." Obstetric healthcare associations should neither sanction nor endorse planned home birth. Instead, these associations should recommend against planned home birth. Obstetric healthcare professionals should respond to expressions of interest in planned home birth by pregnant women by informing them that it incurs significantly increased, preventable perinatal risks, by recommending strongly against planned home birth, and by recommending strongly for planned hospital birth. Obstetric healthcare professionals should routinely provide excellent obstetric care to all women transferred to the hospital from a planned home birth.The professional responsibility model of obstetric ethics requires obstetricians to address and remedy legitimate dissatisfaction with some hospital settings and address patients' concerns about excessive interventions. Creating a sustained culture of comprehensive safety, which cannot be achieved in planned home birth, informed by compassionate and respectful treatment of pregnant women, should be a primary focus of professional obstetric responsibility.

"We wanted a birth experience, not a medical experience": exploring Canadian women's use of midwifery.

In this study I explore Canadian women's use of midwifery to examine whether their choice represents a resistance to the medicalization of pregnancy/childbirth. Through my analysis of the data I identified eight ways the women's deliberate decision to pursue midwifery care represented resistance to medicalization. In so doing, I demonstrate how women actively assert their agency over reproduction thus shaping their own reproductive health experiences. The outcome of their resistance and resultant use of midwifery was empowerment. Theoretically the research contributes to understanding the intentionality of resistance and a continuum of resistant behavior.

Fatores sociodemográficos e via de parto: revisão sistemática / Sociodemographic factors and type of delivery: systematic review / Factores sociodemográficos y tipo de parto: revisión sistemática

Objetivo: identificar os fatores sociodemográficos associados à via de parto. Método: trata-se de revisão sistemática com busca nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, PubMed e Cochrane em maio de 2021. O protocolo do estudo foi registrado na PROSPERO sob o nº CRD42021257340. Os artigos selecionados foram posteriormente analisados pelos sistemas Joanna Briggs Institute e Sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados: mulheres com maior nível socioeconômico, maior nível de escolaridade, com idade acima de 35 anos e parto em instituições privadas possuem maior chance de realizar cesariana comparado ao parto vaginal. A qualidade da evidência para variável de prestador hospitalar foi baixa, para idade e escolaridade materna a qualidade é moderada e classe econômica a qualidade é alta. Conclusões: os fatores sociodemográficos contribuem para o aumento da taxa de cesárea e reforçam o cenário encontrado na literatura.

Objective: to identify the sociodemographic factors associated with the mode of delivery. Method: this is a systematic review with a search in the Latin American and Caribbean Literature on Health Sciences, PubMed and Cochrane databases in May 2021. The study protocol was registered with PROSPERO under number CRD42021257340. The selected articles were analyzed by the Joanna Briggs Institute and the Grading System of Recommendations Assessment, Development and Evaluation systems. Results:women with a higher socioeconomic level, higher education, aged over 35 years and private institutions have a greater chance of having a cesarean section compared to the vaginal level. The quality of quality of quality for the service provider variable was low and the quality of maternal schooling is low and the quality of economic class is high. Conclusion: Sociodemographic conclusions in the literature.

Objetivo: identificar los factores sociodemográficos asociados a la modalidad de parto. Método: se trata de una revisión sistemática con búsqueda en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud, PubMed y Cochrane en mayo de 2021. El protocolo de estudio fue registrado en PROSPERO con el número CRD42021257340. Los artículos seleccionados fueron analizados por el Instituto Joanna Briggs y los sistemas Grading System of Recommendations Assessment, Development and Evaluation. Resultados: las mujeres con mayor nivel socioeconómico, educación superior, mayores de 35 años e instituciones privadas tienen mayor probabilidad de tener una cesárea en comparación con el nivel vaginal. La calidad de calidad de calidad para la variable proveedor de servicios fue baja y la calidad de escolaridad materna es baja y la calidad de clase económica es alta.

The traditional birth attendant: a reality and a challenge.

The traditional birth attendant (TBA) is an institution as old as the birthing process in the human species. Generally a female, in the absence of a better alternative, continues to deliver two thirds of the world's babies. A number of studies generated international interest in training TBAs. A review of TBA training and utilization programs in more than 70 countries over the past three decades revealed that there are very limited examples of their successful utilization. If unsupervised the TBA tends to slide back into her old ways and if unsupported she is rendered helpless when a killer strikes during child birth. The impact of trained TBAs on maternal mortality ratios is not palpable because of other factors such as accessibility of essential obstetric services. The challenge for the policy makers is to make the best use of this available human resource but simultaneously plan and implement a definite replacement strategy.

Traditional birth attendants and their practices in the State of Pernambuco rural area, Brazil, 1996.

OBJECTIVE: To obtain socioeconomic information about TBAs in the State of Pernambuco and information concerning their practices. METHOD: Statistical analysis of the answers to structured questionnaires applied to 127 TBAs. RESULTS: The results of a survey with 127 TBAs conducted in the rural area of the State of Pernambuco (Brazil) is presented in this paper. TBAs in rural Pernambuco are a group of basically old and very poor and uneducated women. Most of them learned to attend births by themselves or by helping another TBA. Thirty percent learned midwifery in hospital delivery rooms, helping doctors and nurses. How the TBAs learned to help births seemed to be the most influential factor on the kind of practices they use. TBAs who learned from other TBAs from the community seem to have the least interventionist approach, followed by the TBAs who learned by themselves. They are more likely to perform more home births and avoid practices such as shaving the pubic hair, vaginal exams, artificial rupture of the membranes, episiotomy and early cord clamping. CONCLUSION: The way women learned midwifery is the most important determinant of their practice.

Postmodern midwives in Japan: the offspring of modern hospital birth.

Although childbirth is fundamentally involved with the issue of women's bodies, it is also involved with such social values as politics, economics, medicine, and other phenomena characteristic of a particular time and culture. In this article I divide Japanese society and childbirth into pre-modern, modern, and postmodern phases, with special emphasis on the postmodern phase. I use the word "postmodern" to denote visible changes in childbirth and midwifery that began to occur around 1990 - changes that distinguish it from modern hospital birth. I conclude that postmodern midwifery is a reaction to and a consequence of modern hospital birth, which failed to satisfy a large number of women's needs. In this sense, postmodern midwifery could rightly be said to be the offspring of modern hospital birth.

[Facts on the topic "gentle birth": a representative survey of Austrian gynecologists]. / Fakten zum Thema "sanfte Geburt": Eine repräsentative Umfrage bei österreichischen Gynäkologen.

With regard to discussions in the public being held in this country throughout the past months, a representative inquiry was carried out among Austrian gynaecologists and obstetricians. Aim of the study was to determine the percentage of obstetricians performing the so-called "birth without violence" according to Leboyer as well as their opinion to this alternative obstetrical thinking: Approximately one half of Austrian gynaecologists is carrying out so-called "births without violence." However, the vast majority of them (78%) prefers for their own wives and their own children "electronic fetal monitoring" during labour and delivery. Analysis of our data according to the age of the doctor, the geographic region of his office, and the number of treated patients shows a considerable discrepancy between performance and personal preference of "alternative" obstetrical methods. These results should be taken into account for further discussions in the public about "births without violence", as obstetricians are among all professions those experts who can estimate the risks of pregnancy and delivery best.

Trends in the modes of delivery and their impact on perinatal mortality rates.

OBJECTIVE: To determine changes in the incidence of vaginal deliveries, cesarean sections, and forceps deliveries and their potential association with fetal, early neonatal, and perinatal mortality rates over time. METHODS: A retrospective study was carried out and the occurrence of deliveries supervised by university services between January 1991 and December 2000 was determined. Data regarding fetal, early neonatal, and perinatal deaths were assessed using obstetric and pediatric records and autopsy reports. RESULTS: Of a total of 33,360 deliveries, the incidence of vaginal deliveries, cesarean sections, and forceps deliveries was relatively steady (around 60, 30, and 10%, respectively) while, at the same time, there was a marked reduction in fetal mortality (from 33.3 to 13.0 per thousand), early neonatal mortality (from 30.6 to 9.0 per thousand), and perinatal mortality (from 56.4 to 19.3 per thousand). CONCLUSIONS: The marked reduction in perinatal mortality rates seen during the study period without an increase in cesarean sections indicates that the decrease in perinatal mortality was not impacted by cesarean section rates. The plausible hypothesis seems to be that the reduction in perinatal mortality of deliveries performed under the supervision of university services was more likely to be associated with better neonatal care rather than the mode of delivery.