Home birth midwifery in the United States: evolutionary origins and modern challenges

Human childbirth is distinct in requiring-or at least strongly profiting from-the assistance of a knowledgeable attendant to support the mother during birth. With economic modernization, the role of that attendant is transformed, and increased access to obstetric interventions may bring biomedicine into conflict with anatomical, physiological, and behavioral adaptations for childbirth. This article provides an overview of the role of midwifery in human evolution and ways in which this evolutionary heritage is reflected in home birth in the contemporary United States. Opportunities remain for evolutionary scholars to apply their knowledge and skills to strengthen culturally consonant, evolutionarily grounded maternity care within a complex, multilevel, pluralistic medical system

Misconceptions surrounding the safety of home birth and hospital birth

Much debate surrounds the topic of women choosing to deliver their infants at home with the services of a midwife. The outcomes of women beginning labor at home, ultimately delivering at home, and the infants born at home were studied in order to determine the safety of home birth among expectant women choosing to be attended by a midwife licensed to practice by the state of Louisiana. Trends associated with those choosing home birth and the frequency of home birth were also analyzed. The study was conducted using retrospective records of clients accepted during the study years 1986-2000. During the study years, the midwives began care on 284 women. Of those women, 225 delivered at home, 31 were transported to the hospital at some point, 7 voluntarily left the midwife’s care, and 20 were referred out for various reasons. The only cause of infant mortality in the home births was congenital anomalies. There were no maternal deaths or significant maternal morbidity. The years with the largest number of home births were 1997, 1998, and 1999 with 32, 35, and 32 births respectively. During these three years there were three actively practicing midwives, with a fourth serving only six women total. The same three midwives were also practicing in 2000, but the number of home births dropped sharply to 20 due to difficulties attaining physician back-up. Most women who chose home birth had already had a child. Only 20.8% were primiparous. Complications and obstetric procedures were infrequent, outcomes were good, and the breastfeeding rate was 100% with most babies being nursed within one hour of birth. The cesarean section rate for all women who began labor with the intention of delivering at home was 6.2%, much lower than the national cesarean rate which averages 22%. Comparisons were also made to vital statistics data available for East Baton Rouge Parish and national records Home birth attended by a licensed midwife is safe and has outcomes as good as or better than that of hospital birth. Home birth with a trained midwife should be a option available to low-risk women

Caesarean section for non-medical reasons at term

Background: Caesarean section rates are progressively rising in many parts of the world. One suggested reason is increasing requests by women for caesarean section in the absence of clear medical indications, such as placenta praevia, HIV infection, contracted pelvis and, arguably, breech presentation or previous caesarean section. The reported benefits of planned caesarean section include greater safety for the baby, less pelvic floor trauma for the mother, avoidance of labour pain and convenience. The potential disadvantages, from observational studies, include increased risk of major morbidity or mortality for the mother, adverse psychological sequelae, and problems in subsequent pregnancies, including uterine scar rupture and greater risk of stillbirth and neonatal morbidity. An unbiased assessment of advantages and disadvantages would assist discussion of what has become a contentious issue in modern obstetrics. Objectives: To assess, from randomised trials, the effects on perinatal and maternal morbidity and mortality, and on maternal psychological morbidity, of planned caesarean delivery versus planned vaginal birth in women with no clear clinical indication for caesarean section. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2009). Selection criteria: All comparisons of intention to perform caesarean section and intention for women to give birth vaginally; random allocation to treatment and control groups; adequate allocation concealment; women at term with single fetuses with cephalic presentations and no clear medical indication for caesarean section. Data collection and analysis: We identified no studies that met the inclusion criteria. Main results: There were no included trials. Authors' conclusions: There is no evidence from randomised controlled trials, upon which to base any practice recommendations regarding planned caesarean section for non-medical reasons at term. In the absence of trial data, there is an urgent need for a systematic review of observational studies and a synthesis of qualitative data to better assess the short- and long-term effects of caesarean section and vaginal birth

Mothers and Children Right and Need for Essential Services Accessibility in Communities

Community play important role to enhance the accessibility to essential rights and services of mothers and children in community. This study utilizes the rapid ethnographic community assessment process (RECAP) to explore community potential for managing accessibility to rights and services of mothers and children in communities. The study was conducted in 8 sub-districts of 8 provinces in 4 regions nationwide. There are 146 informants recruited from purposive sampling include family members, community leaders, local leaders, health care providers, and social groups. Data were collected by the participated observation, in-depth interview, focus group discussion, as well as consultation using interview and focus group guidelines. Data were analyzed using content analysis and thematic analysis. The results reveal two parts include 1) sociocultural context of mothers and children which demonstrate need and way of life of pregnant women and child rearing; and 2) community managing to enhance essential right and service accessibility of mothers and children includes (1) managing fundamental right and services; (2) health services; (3) social welfare and community funds; (4) development safe and learning-enhanced environment; (5) educational services; (6) managing sources of information; and (7) caring based on cultural and traditional way. Based on this findings, national policy makers and relevant stakeholders could be utilizing for improvement prospective development and national policy to reinforce and strengthen community organizations contributing to health development of mothers and children.   Keywords: Rapid Ethnographic Community Assessment Process, Maternal Rights, Child Rights, Services for Mother and Child, Service Accessibility, Community Managemen

A review of caesarean section rates in India: causes for increased prevalence and suggestions for a rational approach

An increasing Caesarian Section (CS) rate places a clinical and economic burden on health care services of the country. When balancing an optimal CS rate, maternal and pediatric outcomes of pregnancy such as maternal morbidity and birth complications should be considered. A CS can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. For society, a caesarean section is more costly than a vaginal delivery. The increased rate of CS can be attributed to medical and non-medical factors like increases in maternal age and body mass index as well as changes in obstetric practice and technology. The WHO has recommended the Robson 10 Group classification as a global standard tool for monitoring CS. This system classifies CS into 10 mutually exclusive groups based on the parity, gestational age at admission, onset of labour, fetal presentation and number of fetuses. The WHO also emphasises that the focus should be to provide caesarean sections to all women in need rather than striving to achieve any specific rate at the population level. It also encourages a shift in the focus from optimal caesarean section rates to more practical proposals which are amenable to action. In the private healthcare setup, commitment to improvement and strategies such as full time availability of obstetricians, better midwife support and regular audits will help move towards an acceptable CS rate. In conclusion, the onus must not be on just reducing CS rates but on scientific methods of deciding when a woman needs the surgery and to ensure safe healthcare environments for the same. Training in obstetrics for specialists must not neglect appropriate procedures like instrumentation

Midwifery: Strategies on the Road to Universal Legalization

Multiple studies have shown that direct-entry midwifery is just as safe, if not safer than, medical care in low-risk childbirth. Most births using direct-entry midwives require fewer interventions than those attended by physicians, yet yield excellent results. The results of these studies indicate that we should return to midwifery for normal births, rather than continuing to rely primarily on medicine. This option, however, has been significantly curtailed by many state legislatures and courts, despite decades of attempts to make incursions on the traditional paradigm of hospital births attended by obstetricians. As a result, where midwifery is more readily available, it is generally available only from certified nurse-midwives, rather than from direct-entry midwives. This article considers why the numerous arguments in favor of direct-entry midwifery and against obstetrical management of most pregnancies have generally been unsuccessful, and why the medical paradigm has – at least to date – generally won the day in the legal arena. It also evaluates what will need to change in order to alter the prevailing attitudes towards birth in the United States