The German poet Heinrich Heine is reported to have said, “When the world comes to an end, I shall go to Holland, for everything there happens fifty years later.” For some, this Dutch “quaintness” explains the unusual system of obstetric care found in the Netherlands, a system where nearly one-third of births occur at home and where midwives have a degree of professional independence unrivaled by midwives in any other country.¹ Heine’s observation about the Netherlands suggests that the unique Dutch way of birth is a vestige from a bygone era—a credible conclusion if you believe that humans are...

New Zealand is a small country with a population of just over 4 million people. We live in relative geographic isolation on two main islands (with a combined land mass greater than the United Kingdom) in the Southern Pacific Ocean, three hours flight time from Australia, which is our nearest neighbor. As a nation, we see ourselves as fiercely independent, yet we have a critical dependence on the vagaries of international markets for income from the sale of our products, mainly consumables, manufacturing, and increasingly, tourism. Politically, we tend toward the center left and pride ourselves on our anti-nuclear stance...

As a profession, Canadian midwifery is a latecomer of sorts, only having been officially integrated into several provincial health care systems beginning as recently as 1994. Prior to this time, Canada had no formally recognized profession of midwifery. Midwives in most Canadian provinces are now autonomous professionals who provide primary, continuous care at home and in the hospital. Midwifery is legally accessible to women in these provinces experiencing normal, uncomplicated pregnancy and birth, and in all but one province where services are provided, it is publicly funded.

Drawing on ethnographic, historical, and sociological data, in this chapter we describe the...

This chapter challenges the assumptions, still held in many postcolonial countries, that the migration and replication of a Western model of birthing is necessarily a desirable goal. The system of maternity care left behind in the Pacific Rim as New Zealanders, Australians, French, or British colonialists moved out is at the very least disappointing. This chapter demonstrates how a group of leaders in one country, Samoa, have made considerable progress in both reconceptualizing and developing a “postcolonial” model of maternity care.

Samoa is a small Pacific island nation northeast of Australia and New Zealand and over 3,500 kilometers west of...

Following the U.K. government reportChanging Childbirthin 1993, a group of midwives working together and desperate for change won the setup money for a groundbreaking midwifery practice. The South East London Midwifery Group Practice (SELMGP) was inaugurated in April 1994 in Deptford, South East London. After three years of excellent outcomes and growing popularity, the group, renamed the Albany Midwifery Practice (AMP), successfully negotiated the first ever subcontract with a healthcare trust in the United Kingdom, becoming the first group of National Health Service (NHS) midwives working as a self-employed, self-managed practice, based in the community and offering continuity...

Birth centers have evolved in many developed countries as an important alternative model to hospital-based, obstetric-led care (Rooks et al. 1989; Saunders et al. 2000; David et al. 1999). Though they are an alternative on the margins, representing just 2%–4% of births in the United Kingdom, their profile is high in the childbirth literature. Increasingly, both quantitative and qualitative research is being undertaken in these settings, and I have been part of these investigations (Walsh and Downe 2004; Walsh 2006). Birth centers contrast to large hospital maternity services in a number of ways: midwife led, small in scale, and...

In this chapter we describe the process of transforming a maternity service at St George Hospital in Sydney from a traditional, medically dominated culture to one that is flexible, woman-centered, and embracing of innovative models of continuity of midwifery care. Both of us were employed to be part of this change, Pat as the clinical midwifery consultant and Caroline as a researcher whose PhD project addressed the research attached to the implementation of the first models we describe here. This process of organizational change and leadership has taken us and others who have worked with us the better part of...

Hospital birth is the norm in almost all industrialized countries, including Japan, where only 1.2% of births take place outside of a hospital. But the significance of this small number is far greater than it appears, for the potential of normal births achieved in maternity homes and at home is so influential that it contributes to maintaining the quality of the rest of the births in Japan. Moreover, research conducted through a grant-in-aid from the Ministry of Health, Welfare, and Labor in 1999 demonstrated that women who gave birth in maternity homes felt more satisfaction and comfort with their births...

After a truly disheartening round of discussions with our local hospital’s administration and nursing staff, pediatrician Charlie Anderson took me and Tish Demmin, my midwifery partner, aside and said, “If you want family-centered care, you’re going to have to start your own birth center.” That was the winter of 1977 in Taos, New Mexico. With those words, we began to create a “working model” for a midwifery practice adventure. Our model is always a work in progress, and we’ve progressed, regressed, reorganized, remodeled, renewed, restructured, and are about to embark on yet another remodeling of the “model that works.”

What...

My name is Ricardo Herbert Jones, and I am an obstetrician. I live in a city in the extreme south of Brazil named Porto Alegre, in the state of Rio Grande do Sul, and I graduated from the Federal University of Rio Grande do Sul in 1985. I work in private practice; that is, women pay out-of-pocket for my services. My cesarean section rates are low, and I work on a sliding scale. All my clients are middle class; they are the women most likely to have a cesarean in the care of any other doctor in my region. This...

The CASA maternity hospital and professional midwifery school are unique in Latin America, perhaps in the world. TheCentro para los Adolescentes de San Miguel de Allende(Center for the Adolescents of San Miguel de Allende) (CASA), in the state of Guanajuato, central Mexico, has developed both birth and midwifery education models with concrete practicality and a judicious combination of science and caring. CASA is a nonprofit health and social service agency offering diverse services that focus on the needs of disadvantaged youth and women. It was established in 1981 by Nadine Goodman, an American-born social worker and public health...

I studied the first 7,565 women admitted for labor and delivery in two charity birth centers that I established in the Philippines through Mercy in Action, the faith-based, nonprofit organization our family founded (see www. mercyinaction.org). The births in this study occurred between February 8, 1996 (the day the first woman delivered in our newly established birth center), and December 31, 2003 (when we ended the study to begin compiling data for my master’s thesis). All the women who were admitted for delivery are included in this reporting. (Women risked out prior to labor are not included in this study.)...

CenteringPregnancy^®, a copyrighted program design, is a multifaceted model that integrates the three major components of prenatal care—health assessment, education, and support—into a unified program within a group setting. Eight to twelve women with similar gestational ages meet as a group with an obstetrical provider—midwife, physician, advanced practice nurse—and a co-facilitator for ten sessions throughout pregnancy and the early postpartum period. Together, they practice self-care skills, participate in facilitated discussions, and develop a support network with other group members. Standard physical health assessment is completed by the practitioner within the group space. Through this unique model...

In July 2006, about six months after participating in one of our seminars, Dr. José Leopoldo dos Santos, director of the Hospital Manoel Novaes, a proud presenter at a state seminar, described the current care offered to delivering women: no early admission, amniotomy only according to the partogram, no routine or liberal use of oxytocin, defined protocols, no restriction of fluids during labor (and soon women will also be allowed to eat), freedom of movement during labor, empathic support from doulas—now women are allowed a companion of their choice by their side—as well as other changes. Now medical...

The focus of this book is to present what is working well for birth around the world, rather than what is not. The purpose of this chapter is to provide a lens with which to examine the midwifery model of care in the United States through a synthesis of my research program about the work of midwives and studies done by other U.S. colleagues. The model I describe is meant to stimulate reflection, research, and policy changes on the most effective and satisfying ways we can work “with women” during childbirth.

It is essential for the reader of this chapter...