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Birth Models That Work

Birth Models That Work

Robbie Davis-Floyd
Lesley Barclay
Betty-Anne Daviss
Jan Tritten
Copyright Date: 2009
Edition: 1
Pages: 496
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  • Book Info
    Birth Models That Work
    Book Description:

    This groundbreaking book takes us around the world in search of birth models that work in order to improve the standard of care for mothers and families everywhere. The contributors describe examples of maternity services from both developing countries and wealthy industrialized societies that apply the latest scientific evidence to support and facilitate normal physiological birth; deal appropriately with complications; and generate excellent birth outcomes—including psychological satisfaction for the mother. The book concludes with a description of the ideology that underlies all these working models—known internationally as the midwifery model of care.

    eISBN: 978-0-520-94333-9
    Subjects: Anthropology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
    (pp. ix-x)
  4. Introduction
    (pp. 1-28)
    Robbie Davis-Floyd, Lesley Barclay, Betty-Anne Daviss and Jan Tritten

    Birth is one of the most powerful of all human experiences, yet it can also be one of the most disempowering. Around the world, there are examples of societies and systems that provide women with true choice, where their desires and wishes and the normal physiology of labor and birth are honored, respected, and trusted. In these places, interventions are applied solely in cases of real need so that their potential misuse does not cause harm. Even though these are only lighthouses in an ocean of over-medicalized care across the globe, their existence shows us that good birth models work—...

  5. PART ONE Large-Scale Systems:: National and Regional Models

    • Chapter 1 The Dutch Obstetrical System: Vanguard of the Future in Maternity Care
      (pp. 31-54)
      Raymond De Vries, Therese A. Wiegers, Beatrijs Smulders and Edwin van Teijlingen

      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...

    • Chapter 2 The New Zealand Maternity System: A Midwifery Renaissance
      (pp. 55-88)
      Chris Hendry

      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...

    • Chapter 3 The Ontario Midwifery Model of Care
      (pp. 89-118)
      Margaret E. MacDonald and Ivy Lynn Bourgeault

      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...

    • Chapter 4 Samoan Midwives’ Stories: Joining Social and Professional Midwives in New Models of Birth
      (pp. 119-138)
      Lesley Barclay Utumuu

      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...

  6. PART TWO Local Models in Developed Nations:: Hospitals and Birth Centers

    • Chapter 5 The Albany Midwifery Practice
      (pp. 141-158)
      Becky Reed and Cathy Walton

      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...

    • Chapter 6 Small Really Is Beautiful: Tales from a Freestanding Birth Center in England
      (pp. 159-186)
      Denis Walsh

      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...

    • Chapter 7 Transforming the Culture of a Maternity Service: St George Hospital, Sydney, Australia
      (pp. 187-212)
      Pat Brodie and Caroline Homer

      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...

    • Chapter 8 Maternity Homes in Japan: Reservoirs of Normal Childbirth
      (pp. 213-238)
      Etsuko Matsuoka and Fumiko Hinokuma

      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...

    • Chapter 9 The Northern New Mexico Midwifery Center Model, Taos, New Mexico
      (pp. 239-268)
      Elizabeth Gilmore

      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.”


  7. PART THREE Local Models in Developing Nations:: Traditional Midwives, Professional Midwives, And Obstetricians Working Together

    • Chapter 10 Teamwork: An Obstetrician, a Midwife, and a Doula in Brazil
      (pp. 271-304)
      Ricardo Herbert Jones

      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...

    • Chapter 11 The CASA Hospital and Professional Midwifery School: An Education and Practice Model That Works
      (pp. 305-336)
      Lisa Mills and Robbie Davis-Floyd

      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...

    • Chapter 12 Mercy in Action: Bringing Mother- and Baby-Friendly Birth Centers to the Philippines
      (pp. 337-362)
      Vicki Penwell

      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. 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.)...

  8. PART FOUR Making Models Work

    • Chapter 13 Circles of Community: The CenteringPregnancy Group Prenatal Care Model
      (pp. 365-384)
      Sharon Schindler Rising and Rima Jolivet

      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...

    • Chapter 14 Humanizing Childbirth to Reduce Maternal and Neonatal Mortality: A National Effort in Brazil
      (pp. 385-414)
      Daphne Rattner, Isa Paula Hamouche Abreu, Maria José de Oliveira Araújo and Adson Roberto França Santos

      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...

    • Chapter 15 “Orchestrating Normal”: The Conduct of Midwifery in the United States
      (pp. 415-440)
      Holly Powell Kennedy

      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...

  9. Conclusion
    (pp. 441-462)
    Robbie Davis-Floyd, Lesley Barclay, Betty-Anne Daviss and Jan Tritten

    In 2002 Ellen Hodnett carried out a systematic review of 137 reports on factors influencing women’s evaluations of their childbirth experiences. Her objective was to summarize what was known about satisfaction with childbirth, with particular attention to the roles of pain and pain relief. The reports included in Hodnett’s review included descriptive studies, randomized controlled trials, and reviews of intrapartum interventions. The results were as follows: “Four factors—personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship, and involvement in decision making—appear to be so important that they override the influences of age, socioeconomic...

    (pp. 463-472)
  11. INDEX
    (pp. 473-484)
  12. Back Matter
    (pp. 485-485)