The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings.

This book provides an introduction to the sociological study of midwifery. The readings have been selected to highlight the interplay between midwifery and medicine, reflecting the medicalization of childbirth. It highlights the major themes in both a historical and a current context, as well as western and non-western societies. Two major themes underlie the organization of this book: that the conception of midwifery must be broadened to encompass a sociological perspective; and that the ongoing trend toward the medicalization of midwifery is crucial to an understanding of the historical, current, and future status of midwifery. By medicalization of childbirth and midwifery the author mean the increasing tendency for women to prefer a hospital delivery to a home delivery, the increasing trend toward the use of technology and clinical intervention in childbirth, and the determination of medical practitioners to confine the role played by midwives in pregnancy and childbirth, if any, to a purely subordinate one.

The World Health Organization is currently promoting a policy of replacing traditional or lay midwives in countries around the world. As part of an effort to record the knowledge of local midwives before it is lost, Midwives and Mothers explores birth, illness, death, and survival on a Guatemalan sugar and coffee plantation, or finca, through the lives of two local midwives, Do�a Maria and her daughter Do�a Siriaca, and the women they have served over a forty-year period. By comparing the practices and beliefs of the mother and daughter, Sheila Cosminsky shows the dynamics of the medicalization process and the contestation between the midwives and biomedical personnel, as the latter try to impose their system as the authoritative one. She discusses how the midwives syncretize, integrate, or reject elements from Mayan, Spanish, and biomedical systems. The midwives' story becomes a lens for understanding the impact of medicalization on people's lives and the ways in which women's bodies have become contested terrain between traditional and contemporary medical practices. Cosminsky also makes recommendations for how ethno-obstetric and biomedical systems may be accommodated, articulated, or integrated. Finally, she places the changes in the birthing system in the larger context of changes in the plantation system, including the elimination of coffee growing, which has made women, traditionally the primary harvesters of coffee beans, more economically dependent on men.

Improving how individuals give birth and die in the United States requires reforming the regulatory, reimbursement, and legal structures that centralize care in hospitals and prevent the growth of community-based alternatives. In 1900, most Americans gave birth and died at home, with minimal medical intervention. By contrast, most Americans today begin and end their lives in hospitals. The medicalization we now see is due in large part to federal and state policies that draw patients away from community-based providers, such as birth centers and hospice care, and toward the most intensive and costliest kinds of care. But the evidence suggests that birthing and dying people receive too much—even harmful—medical intervention. In The Medicalization of Birth and Death, political scientist Lauren K. Hall describes how and why birth and death became medicalized events. While hospitalization provides certain benefits, she acknowledges, it also creates harms, limiting patient autonomy, driving up costs, and causing a cascade of interventions, many with serious side effects. Tracing the regulatory, legal, and financial policies that centralize care during birth and death, Hall argues that medicalization reduces competition, stifles innovation, and prevents individuals from accessing the most appropriate care during their most vulnerable moments. She also examines the profound implications of policy-enforced medicalization on informed consent and shows how medicalization challenges the healthcare community's most foundational ethical commitments. Drawing on interviews with medical and nonmedical healthcare providers, as well as surveys of patients and their families, Hall provides a broad overview of the costs, benefits, and origins of medicalized birth and death. The Medicalization of Birth and Death is required reading for academics, patients, providers, policymakers, and anyone else interested in how policy shapes healthcare options and limits patients and providers during life's most profound moments.

As Puerto Rico rapidly industrialized from the late 1940s until the 1970s, the social, political, and economic landscape changed profoundly. In the realm of heath care, the development of medical education, new medical technologies, and a new faith in science radically redefined childbirth and its practice. What had traditionally been a home-based, family-oriented process, assisted by women and midwives and "accomplished" by mothers, became a medicalized, hospital-based procedure, "accomplished" and directed by biomedical, predominantly male, practitioners, and, ultimately reconfigured, after the 1980s, into a technocratic model of childbirth, driven by doctors' fears of malpractice suits and hospitals' corporate concerns. Pushing in Silence charts the medicalization of childbirth in Puerto Rico and demonstrates how biomedicine is culturally constructed within regional and historical contexts. Prior to 1950, registered midwives on the island outnumbered registered doctors by two to one, and they attended well over half of all deliveries. Isabel M. Córdova traces how, over the next quarter-century, midwifery almost completely disappeared as state programs led by scientifically trained experts and organized by bureaucratic institutions restructured and formalized birthing practices. Only after cesarean rates skyrocketed in the 1980s and 1990s did midwifery make a modest return through the practices of five newly trained midwives. This history, which mirrors similar patterns in the United States and elsewhere, adds an important new chapter to the development of medicine and technology in Latin America.

Meticulously documented, Optimal Care in Childbirth pulls back the curtain on medical-model management of childbirth. Written for those who want to practice according to the best evidence, assist women in making informed decisions, or advocate for maternity care reforms, it provides an in-depth analysis of the evidence basis for physiologic care.

First Published in 1996. Routledge is an imprint of Taylor & Francis, an informa company.