Great article/research paper about midwifery led care

[Cricket]

Came across this article today. It's a summary of another research paper on prenatal care and labour and delivery. Some excellent points! Have a read, and maybe include some elements in your letters to the government.

Safety of Alternative Approaches to Childbirth / VBFree.org - the link takes you to a page with a link to the entire research paper.

Here's the summary:

For his doctoral dissertation written at Stanford University, Peter F. Schlenzka recently finished an extensive study of perinatal outcomes in out-of-hospital and in-hospital births. Outlining his reason for undertaking the study, Schlenzka states that research has suggested that the "medicalization of childbirth and the move of childbirth from home to the hospital might not have improved the outcomes for these low risk pregnancies" which constitute 60-80% of all pregnancies (p. 1). In his own research, Schlenzka sets out to study perinatal mortality of pregnant women with equal risk levels to determine whether or not "the non-interventionist natural approach to childbirth, as administered by midwives and some physicians in free-standing birth centers or at home, is as safe as the interventionist obstetric approach in hospitals." His methodology allows for insights into the outcomes of both low-risk and high-risk pregnancies and births—in and out of the hospital. In addition, Schlenzka examines evidence of the "overall social and economic cost to society" of these two approaches to maternal care (p. 3).



As is standard in all doctoral research, Schlenzka has conducted a thorough review of scientific literature which pertains to the study he undertakes in this dissertation. His bibliography consists of 189 references and he includes over 50 pages of literature review on such topics of the medicalization of childbirth, the shift from home-birth to hospital birth, the safety of obstetric and natural approaches, and the re-emergence of midwifery. Some critical statements he cites from others’ research are cited on pages three and four of this summary.



In his study, Schlenzka examines information from live birth and fetal death records for children in the 1989 and 1990 birth cohort, hospital discharge data reporting medical risk factors, and various information about free-standing birth centers. After careful matching of all appropriate data, Schlenzka examines perinatal outcomes of nearly 816,000 births, comparing low risk births outside and inside the hospital and high-risk births outside and inside the hospital. His findings clearly show that the natural approach and obstetric approach produce the same perinatal mortality outcomes for both low-risk and high-risk births. Thus, he concludes: "the obstetric approach cannot claim to have lower perinatal mortality rates than the natural approach to childbirth," with the natural approach in this case being defined as births planned in out-of-hospital settings—that is, at home or in a free-birth center (p. 175, 174).



To examine the social and economic costs of birth, Schlenzka’s study compares "the present hospital-based obstetric care system with a shared maternity care system where midwives are the primary caregivers attending low-risk women (the majority of all pregnancies) and using the natural approach while obstetricians use their interventionist approach only for the remaining cases with complications" (p. 175). His first observation is that "a shared maternity care system would lower the cost for childbirth by roughly 40%, or $13.143 billions" (p. 175).



Schlenzka also suggests that under the shared maternity care model, there would be a lessening of costs from the reduction of unnecessary cesareans and other obstetric interventions. Finally, he reviews research that suggests that a wide variety of social ills that have been linked to birth trauma, such as lack of bonding between the mother and infant, involve a great economic and social cost to society--and that a less interventive birth model would reduce these ills. From this analysis, Schlenzka concludes that the "apparent disadvantages of the obstetric approach have such large order of magnitude, that in any clinical trial it would be considered unethical to continue with the obstetric ‘treatment’"

(p. 175).



Schlenzka’s data from more than 800,000 births show no advantage of the obstetric approach for either low or high risk women. Furthermore, Schlenzka is able to show a slightly (though not significantly) better outcome in terms of lower perinatal mortality for low-risk women who opt for out-of hospital settings. After analyzing all of his data on perinatal outcomes, Schlenzka states the following

(p. 153):



Under no circumstances do the California data for 1989 and 1990 allow the obstetric profession to uphold the claim that for the large majority of low-risk women hospital birth is "safer" with respect to perinatal mortality. Our data also suggest that even for the high-risk levels of our Study Population the natural approach (including transfers) produces the same perinatal mortality outcomes as the obstetric approach.



In his abstract, Schlenzka concludes (p. iv-v):

Given no differences in perinatal mortality it must be noted that the natural approach shows significant advantages with respect to lower maternity care cost as well as reduced mortality and morbidity from unnecessary cesareans and other obstetric interventions, and significant benefits from avoiding negative long-term consequences from unnecessary obstetric interventions and procedures. These advantages of the natural approach are of such a large order of magnitude as to raise serious doubts concerning the appropriateness of conventional "obstetric" treatment for low-risk childbirth.

[Bella29]

That's great cricket thanks!