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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!

Discussion Forum

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Comment Wall


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Comment by Jessica Fox on September 24, 2010 at 11:16am
wow, that's a beautiful story, I'm so happy for you! and BTW your daughter is so cute!
Comment by Tarrah Carmon on September 24, 2010 at 10:20am
SOOOOOOOOO sorry iv been gone for awhile! been super busy BUT here is a link to my birth story that my doula wrote!
Comment by naomi on September 5, 2010 at 5:09pm
so I started having some contractions but there morel ike braxton hicks I called my dr just to ask her about it she had me come in due to my history of having premies they checked me had me walk around to see if it made me dialate kind of ridicouls but anyway checked me twice again. I've had five checks so far and I'm 36 weeks. I didn't realize that cervical checks can cause infection at least thats what I read online. I thought the mucas plug and back of water protected the baby from that. Is it possible my daughter could get an infection from these checks possiblebe born with one. I worry because with my first daughter my water broke 27 hours later she was born she had an infection they said it wasen't preexisting which means it happend after my water broke still dont know what caused that they only did two cervical checks on me that time . I'm worried I did more harm then good now should have told them no had I known about this I might of. what do you all think or know about this?
Comment by Katie on September 4, 2010 at 4:47am
I'll tell you what my midwife just told me at our appointment last week when I asked her the same question: "If you have to wonder if they are real contractions or not, then they're probably not." Of course, I'm sure there are exceptions! I think your body will likely "tell" you, in no uncertain terms, if they are real contrax or not...but it's probably best to err on the side of caution. If you go to the hospital and it's false labor, it's not the end of the world. (On the flip side, if you don't make it to the hospital in time, it's not the end of the world, either! You'll just be our newest home-birthin' mama-- ha ha!)
Glad to hear this baby is holding on tight!
Comment by naomi on September 3, 2010 at 7:12pm
Okay so I had my daughter at 35 weeks my water broke they had to give me pitocin to start my labor as I didn't contract on my own. I'm 36 weeks never got this far so my question is since all I have to comare to is pitocin contractions. Will I know when I'm having contractions are they obvous probobly sounds stupid lol. What do they feel like? I've been gettting mild pms cramps on and off and a tighting there but it's random and baby also likes to push on my stomach alot. Dr said to call when there 7-8min a part for an hour since it's my second baby labor tends to go faster majority of the time. When should I call my family to come take care of my daughter? At same time? I dont want to call them to late as it could take them half our or so to get there and end up just making it to hospital.
Comment by Meredith Paige Browning Lovell on August 30, 2010 at 1:49pm
Marina- I guess it depends on what you are snacking on. I find myself wanting snacks but try and make better choices. So I steam broccoli or carrots, eat hummus; just trying to make filling and better choices than potato chips. If you eat higher fiber or protien (nuts, I love almonds) you feel fuller longer. Hope it helps.
Comment by Bella on August 30, 2010 at 12:41pm
A great book to read is Pregnancy Sickness by Margie Profet. Also google risks of Dopplers and Ultrasounds.
Comment by Marina Bunnell on August 30, 2010 at 11:47am
Hi everyone! just few days ago we found out that I am pregnant! So I thought to join this pregnancy group to share on what I am going through and read about other's stories :-)

Here is my story...
We've been trying to conceive our baby#1 since may or 3 cycles (my cycles were 45 days)...
So I was waiting for my period to come on 8/24 and around that time I was feeling like it was really coming (PMS) My nipples were sore,I was too emotional,my face breaking out, and closer to the day I started to have light cramps. Well, the day came and went and no period! I thought well there is a chance I am pregnant but I will wait for a week to test because it might be too early to show. But eventually i got too curious and bought the test on 4th day and tested next morning. The vertical line on the test was so vivid that i had no doubt I was pregnant! So now since the day I found out I have been very hungry even at night,my boobs are killing me,I don't have nausea and don't have problem with smells but I do have light cramps in my uterus that come and go. I am definitely googling on everything I need to know right now :-) But overall I am feeling good so far,my outlook is positive,I am really happy and can't wait to tell everybody!

P.S. I also have a question...
I am not used to snaking or eating between meals,I don't have a strict schedule of eating times but I just don't eat between meals.My question is, since I am pregnant now and feel hungry more often should i eat more often too? I mean if it's ok to still eat 3 times a day without harming the baby,I can do it,I can cope with hunger until the next meal. But I guess my question is does BABY need me eating more often for him? Any way I would really appreciate any of your answers and opinions.
Comment by Evangelia on August 23, 2010 at 2:19pm

You can try ginger supplements 1 gram a day divided in 4 doses. Also, taking vitamin B6 supplements 10-25 mg 3 times a day can be helpful. Bendectin, a nausea/vomiting medication available in Canada, can be "made" here at home by taking 25 mg of B6 and 1/2 a tab of OTC Unisom (12.5 mg) UP TO 3 times a day. The Unisom may make you a little drowsy so try it for the first time on a day off or in the evening. Good luck!
Comment by Jane Doe on August 9, 2010 at 8:34am
Anyone have any tips on dealing with nausea in the first trimester?? I don't have trouble keeping everything down, it's just getting it in that's tricky. Nothing looks good to me (except for McDonald's vanilla icecream cones strangely enough). It sure is tough to deal with feeling sick everyday since I work full time!

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