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Midwifery care and out-of-hospital birth settings: How do they reduce unnecessary cesarean section births?

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  • Sakala, Carol

Abstract

In studies using matched or adjusted cohorts, U.S. 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 outcome measures. 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 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 contrast 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 births in the U.S. have failed to highlight the substantial reduction in such births that may be expected to accompany greatly 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 greatly expanded use of midwives and out-of-hospital birth settings.

Suggested Citation

  • Sakala, Carol, 1993. "Midwifery care and out-of-hospital birth settings: How do they reduce unnecessary cesarean section births?," Social Science & Medicine, Elsevier, vol. 37(10), pages 1233-1250, November.
  • Handle: RePEc:eee:socmed:v:37:y:1993:i:10:p:1233-1250
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    Citations

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    Cited by:

    1. Edwin van Teijlingen, 2005. "A Critical Analysis of the Medical Model as used in the Study of Pregnancy and Childbirth," Sociological Research Online, , vol. 10(2), pages 63-77, July.
    2. Pitchforth, Emma & Lilford, Richard J. & Kebede, Yigzaw & Asres, Getahun & Stanford, Charlotte & Frost, Jodie, 2010. "Assessing and understanding quality of care in a labour ward: A pilot study combining clinical and social science perspectives in Gondar, Ethiopia," Social Science & Medicine, Elsevier, vol. 71(10), pages 1739-1748, November.
    3. Wang, Eileen, 2017. "Requests for cesarean deliveries: The politics of labor pain and pain relief in Shanghai, China," Social Science & Medicine, Elsevier, vol. 173(C), pages 1-8.

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