Sakala, C, HEALTH POLICY INSTITUTE, BOSTON UNIVERSITY, MA 02215
SOCIAL SCIENCE AND MEDICINE 37(10): 1233-50, 1993, Nov

Abstract: In the US women beginning labor with midwives and/or in out-of-hospital settings have attained cesarean section rates that are considerably lower than similar women using prevailing forms of care -- physicians in hospitals. This Cesarean reduction involved no compromise in mortality and morbidity outcomes. Moreover, groups of women at elevated risk for adverse perinatal outcomes have attained excellent outcomes and cesarean rates well below the general population rate with these [midwifery) care arrangements.

How do midwives and out-of-hospital birth settings so effectively help women to avoid unnecessary cesareans.

This paper explores this question by presenting data from interviews with midwives who work in home settings. The midwives’ understanding of and approaches to major medical indications for cesarean birth contrasts strikingly with prevailing medical knowledge and practice. From the midwives perspective, many women receive cesareans due to pseudo-problems, to problems that might easily be prevented or to problems that might be addressed through less drastic measures.

Policy reports addressing the problem of unnecessary cesarean birth in the US have failed to highlight the substantial reduction in such (surgical) births that may be expected to accompany expanded use of midwives and out-of-hospital birth settings.

The present study -- together with cohort studies documenting such a reduction, studies showing other benefits of such forms of care and the increasing reluctance of physicians to provide obstetrical services -- suggests that childbearing families would realize many benefits from the greatly expanded use of midwives and OOH birth locations.

Midwifery Care and Out-of-Hospital Birth Setting: How do they reduce Unnecessary Cesarean Section Births?

...the already apparent disadvantages of the obstetric approach have such large order of magnitude, that in any clinical trial it would be considered unethical to continue with the obstetric "treatment" . The safety of Alternative Approaches to Childbirth, Peter Schlenzka, Ph.D., MBA, MS, Stanford, 1999