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Consumer Reports: Back to Basics for Safer Childbirth

When it’s time to bring a new baby into the world, there’s a lot to be said for letting nature take the lead. The normal, hormone-driven changes in the body that naturally occur during delivery can optimize infant health and encourage the easy establishment and continuation of breastfeeding and mother-baby attachment. Childbirth without technical intervention can succeed in leading to a good outcome for mother and child, according to a new report. (Take our maternity-care quiz to test your knowledge.)

“Evidence-Based Maternity Care: What It Is and What It Can Achieve,” co-authored by Carol Sakala and Maureen P. Corry of the nonprofit Childbirth Connection analyzed hundreds of the most recent studies and systematic reviews of maternity care. The 70-page report was issued collaboratively by Childbirth Connection, the Reforming States Group (a voluntary association of state-level health policymakers), and Milbank Memorial Fund, and released on Oct. 8, 2008.

The report found that, in the U.S., too many healthy women with low-risk pregnancies are being routinely subjected to high-tech or invasive interventions that should be reserved for higher-risk pregnancies. Such measures include:

Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005

Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests
Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization’s recommended national rate of 5 to 10 percent
Electronic fetal monitoring, unnecessarily adding to delivery costs
Rupturing membranes (”breaking the waters”), intending to hasten onset of labor

Episiotomy, which is often unnecessary

In fact, the current style of maternity care is so procedure-intensive that 6 of the 15 most common hospital procedures used in the entire U.S. are related to childbirth. Although most childbearing women in this country are healthy and at low risk for childbirth complications, national surveys reveal that essentially all women who give
birth in U.S. hospitals have high rates of use of complex interventions, with risks of adverse effects.

The reasons for this overuse might have more to do with profit and liability issues than with optimal care, the report points out. Hospitals and care providers can increase their insurance reimbursements by administering costly high-tech interventions rather than just watching, waiting, and shepherding the natural process of childbirth.

Convenience for health care workers and patients might be another factor. Naturally occurring labor is not limited to typical working hours. Evidence also shows that a disproportionate amount of tech-driven interventions like Caesarean sections occur during weekday “business hours,” rather than at night, on weekends, or on holidays.


Many practices that have been proven effective and do little to no harm are underused in today’s maternity care for healthy low-risk women. They include:

Prenatal vitamins
Use of midwife or family physician
Continuous presence of a companion for the mother during labor
Upright and side-lying positions during labor and delivery, which are associated with less severe pain than lying down on one’s back
Vaginal birth (VBAC) for most women who have had a previous Caesarean section
Early mother-baby skin-to-skin contact
The study suggests that those and other low-cost, beneficial practices are not routinely practiced for several reasons, including limited scope for economic gain, lack of national standards to measure providers’ performance, and a medical tradition that doesn’t prioritize the measurement of adverse effects, or take them into account.

3 Responses to ““Back to Basics for Safer Childbirth” Consumer Reports Article”

February 24th, 2009 at 11:09 pm edit
Isis says:
Thanks for posting this its about time the rest of the media caught up to this.

February 26th, 2009 at 9:39 am edit
rachel moses says:
it is so great to see this issue of mistreatment of birth being addressed in the mainstream media. having had 2 home births myself, i am totally horrified disgusted by the invasive abusive treatment i see most of the women around me receiving at their hospital births. lets get this straightened out ladies! walking through the doors of a hospital as a pregnant woman put you/baby way too much danger. drugged up moms and newborns and 30+% c-section rate? come on, this is just not acceptable. Also in serious question ought to be all this “scanning” of babies in the womb; just 30 years ago x-rays were supposdly safe and we now know of course taht they are not. How about the pathetically low (1%) of babies who are breastfed to the World Health Organzation’s reccommended TWO FULL YEARS. And further, what is up with all this machine milking women to bottle feed babies with? its disgusting, and even the La Leche league organization seems to accept it as an equivalent when it clearly is NOT. It negates all of the importance of the MOTHER being with the baby. What no one is talking about either are the far reaching effects. lets hear more about these issues!

February 27th, 2009 at 1:22 am edit
Kate Quick says:
Machine milking women to bottle feed babies? Well, if women who want to breastfeed don’t hook themselves up to machines, they have three options. 1)Take their babies to work with them, which most employers won’t allow and which probably isn’t that feasible once babies can crawl, at least not without a playpen, which is a whole different argument. 2) Take a much much longer maternity leave than any employer I’ve ever heard of will pay for or even grant unpaid. 3) Stay at home with her babes. It all comes down to economics and misplaced priorities. The same is true of maternity care…economics and mislplaced priorities. It’s time to reprioritize. Let’s put moms and babes first, for a change. Longer maternity leaves for working women, respect for midwives and women who use them, and a little more anger at the mistreatment of women birthing in a hospital setting. Oh yeah, and a little more faith in our bodies’ ability to give birth!

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Comment Wall


You need to be a member of Pregnancy to add comments!

Comment by Katie on July 14, 2010 at 4:56am
Congrats, Jane! :) I didn't have a sore belly, but I did feel tight and bloated in my lower abdominal area for the first several weeks. I had a few days of very light spotting/mild cramping around week 6, but not enough to raise any concern. I would venture to guess that your symptoms are very normal for early pregnancy (but of course with the added caution of making sure to monitor your soreness for signs of worsening.) Congrats to you!! Are you due around mid-March?
Comment by Jane Doe on July 13, 2010 at 3:59pm
Hi everyone! I'm new to this group, just got my BFP last week and DH and I are so excited! I'm almost 5 weeks now. I was wondering, did anyone else have a sore belly (not period-like cramps) in these early weeks? Is that normal?
Comment by Jessica Fox on July 12, 2010 at 3:59pm
Apparently it was a dose of false labor, things got really intense for a while and I lost some of my mucus plug but then they suddenly fizzled out by Sunday night and I am back to normal.
A doula friend seems to think that the solar eclipse was stirring things up (apparently full and new moons tend to do that) but baby wasn't playing along yet.
Comment by Mandy Gibbs on July 12, 2010 at 3:39pm
Jessica...I have no idea what to tell you!! I am still waiting to see what real labor feels like and this is my second pregnancy. With my first the only thing that happened was my water started leaking...Never had a single contraction until they started the pitocin and then it just felt like horrible periods cramps!! I keep thinking I am not going to know when I go into labot BUT obviously I going too...Good Luck though...Keep Us Updated!!

Yay, Meredith...that is one of the best moments during pregnancy!!
Comment by Meredith Paige Browning Lovell on July 11, 2010 at 9:43am
Exciting news Ladies. Dear sweet Evan got to feel the baby move last night!
Comment by Katie on July 11, 2010 at 5:24am
Ooh, Jessica! I've not yet experienced the "real thing", but my midwives told me if I have BH contractions more than 8-10 per hour for more than 2 hours (despite relaxing techniques like warm bath, small glass of wine, lots of H20, etc...) that it could be labor. My question pertained more to signs of preterm labor, but I assume it could apply to term labor as well?? How exciting! Keep us posted!!
Comment by Jessica Fox on July 11, 2010 at 4:56am
I've been feeling "weird" since 5pm yesterday. Started with what I considered BH as it was just a tightening of the belly with no pain 15 mins apart, steadily increased pace throughout the night and are now 4 mins apart, 1 min long but still don't hurt. I only get a painful one about 1 in every 8 contractions. Don't know what this means

Should I be giving the midwife a heads up or get dressed to go to work? (I'm 38 w 3d)
Comment by Brittany Tubb on July 6, 2010 at 6:53pm
lol sooo true about both of them. that was the reason i nearly went into labor 5 weeks early with my first! lol....and my second pregnancy i just started moving into a new house and lots of yard work. i wanted him here early...he was causing me to lose weight and i was afraid something was wrong.
Comment by naomi on July 6, 2010 at 5:29pm
I always thought it was semen as well until I read it is orgasm thats why when your done having orgasm shortly after you can have craping even in beginning of pregancy.
Comment by naomi on July 6, 2010 at 5:28pm
yeah it's tru mandy it is orgasm that sends you into labor. As of friday I'll be seven months and from what I've read woman that are prone to early labors should obstain from sex as of 3rd trimester so I'm folowing what I read although I had no sex with my daughter and still went in five weeks eearly so who knows but I'll try anything to not go in early and hey gives me an excuse as sex these days is and obstacle with thebelly and I have no urge lol.

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