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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 Darcel on May 12, 2009 at 3:00pm
That's a nice area. My best friend lives out there. You'll love it!
Comment by Darcel on May 12, 2009 at 12:47pm
Justine, where exactly in Dayton are you? I ask because I used to I grew up in Dayton.

Here's a list of MW's in your area. best wishes :)
Comment by Darcel on May 11, 2009 at 3:06pm
Karissa, what are your thoughts and concerns?
Comment by karissa trueax on May 11, 2009 at 2:43pm
hi all just saw the show and it was intresting....
im 5 almost 6 months pregnant and im not sure if i wanna go all natural or not... im haveing difficultys desiding...
Comment by Jeanne Madrid on May 11, 2009 at 2:21pm
From a midwife's point of view: I think anyone that can be convinced to consume their own placenta is just a gimmick. Really ladies during your pregnancy you need to eat a good diet and have your H/H checked at the beginning, 28 weeks and 36 weeks. There are lots of things you can do to have yourself and your baby ready. The placenta is expelled for a good reason. It has done it's work and doesn't need to go back in the other end.
Comment by Chari on May 11, 2009 at 2:05pm
hi just joined the group i just saw Ricki Lake on the Drs show. it was really intersting . i am 7 months pregnant with our first child . i have a obgyn for all my appointments .and she will be dilverying our little boy . and i plan on doing it all natural birth.
Comment by Amber-joy Tacey on May 7, 2009 at 8:18pm
Hey Coralissa, I have a discussion page on Placenta building under Homebirthers. Please join in we'd love to chat with you about Encapsulation and hear your ideas. I actually know of a lady here in CO that does it.
Comment by Coralissa on May 7, 2009 at 7:42pm
Hello all! Just wanted to know anyone's thoughts on Placenta Encapsulation.

I am 37 1/2 weeks and we are having a home waterbirth in Vegas.

Looking forward to any comments or thoughts!
Comment by Darcel on May 7, 2009 at 3:36pm
I gave birth to my daughter with my butt in the bathroom and my upper body in the hallway. My friend gave birth in her bathroom on the toilet(lid was closed) we used the same midwife and doula.
Birth can be messy, but like the previous poster said, they clean everything up. They even brought me food to my bed, they stayed for about 2 hours after Ava was born.

Let us know how your appointment goes!
Comment by Amber-joy Tacey on May 7, 2009 at 2:29pm
Hey Dasha I just wanted to say I've had 3 home births and I haven't found it to be messy at all. My attendants were very neat and clean I'd say my house was cleaner after they left. As far as space goes I think midwives are used to working in small areas seeing as that is where most women choose to birth.

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