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Sunday, April 20, 2008

Interesting &/or Important Documents 


American College
of  Community Midwives

A professional organization

General Content


British Medical Journal   2005;330:1416 (18 June), doi:10.1136/bmj.330.7505.1416

Outcomes of planned home births with certified professional midwives: large prospective study in North America

by Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager

Editor's Note: Many of the LMs in California were participants in this study and contributed statistics from our own home birth practices.

BMJ March 13, 2006 Press Release:   
ost popular study published in 2005 was Ken Johnson's paper on Planned Home Birth
ACOG Policy Statements on Midwifery & PHB Feb. 2006


The Myth of the Ideal Cesarean Section Rate:
American Journal of Obstetrics & Gynecology 2005

Excerpts from this article, page 935 & 936, paragraph #4 

In Europe , better perinatal outcomes are achieved with lower cesarean rates and less spend on healthy care. In those countries, midwives manage most low-risk pregnancies, with obstetricians acting as consultants. How did procedure-oriented specialists (referring to obstetricians) come to perform midwifery and well-woman care in the US ?

 Paragraph #6: Although trained midwives provide safe obstetrics care, with lower cesareans sections rates, they attend only 7% of births in the US – working mostly in environment where they don’t complete economically with doctors.

 Page 936, paragraph #1: In truth the average obstetrician-gynecologist compares poorly to the family practitioner in the breadth of her training for primary care, and there is little office obstetrics and gynecology that cannot be performed competently by midlevel practitioners. In teaching hospitals, the reduced work schedule of residents is creating service needs that can only be addressed by in-hospital personnel.

 Because, by training and inclination, obstetricians spend little time and support during labor – why not phase out the generalist (non-perinatologist obstetricians) altogether? 

A self-regulated midwifery profession, working in collaborative practice with consulting perinatologists, would appear to provide a better model for obstetric care [actually for midwifery in the historical sense of the term i.e., non surgical maternity care to healthy childbearing women]



Cesarean Section Delivery Rates and Pregnancy Outcomes: 
2005 WHO Global Survey in Latin America ~ Lancet


Antenatal Fear of Childbirth and its association with subsequent 
Cesarean Sections and experience of childbirth ~ Sweden: BJOG 2006 


Faith's September 11th, 2004  Letter to MBC 

Karen Ehrlich's Letter to Local Hospital"s Grand Rounds Committee on BMJ study

"The Calling"  ~ 
an article from the MANA newsletter Dec 1994


The Journal of the American College of Obstetricians & Gynecologists ~ 2002
Biased & Misleading 

"Outcomes of Planned Home Births in Washington State"  

1. Letter to Editor / Op Ed    & Press Release 2. ACOG letter MBC  
3. Synopsis /Comments 4. Comprehensive Review   


Originally published in
 a professional journal 
for physicians
"Continuing Education"  
June 1984 * pages 315-320

Editorial ~ Home Delivery   
-- Why?

Michael Fleming, MD, Assistant Professor, Department of Family Medicine, School Medicine, University of North Carolina, Chapel Hill

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