Midwives' experience of normalcy in childbirth admits a broad continuum of healthy variations, differing from the narrow parameters held in the predominant maternity care culture. Midwives consider the woman's nature and the context of childbirth to be interactive and significant in explaining variations in the woman's childbirth experience. The contextual environment is considered to be the most influential dynamic affecting the normalcy of childbirth.
The practice of midwifery reflects the spectrum of diversity among midwives and the women they serve, yet the composition of midwives in ACNM does not reflect the diversity of the women for whom they provide care. Providing culturally appropriate care for women requires our best understanding of their beliefs, needs, and desires; it also requires a wide range of diverse clinicians. This study proposed to learn more about the practice of midwifery from a diverse sample of midwives. A qualitative research design, which included small group interviews, videotape collection of data, and content analysis, was used. Four major themes were identified: 1) the worldview of midwifery through the lens of diversity, 2) the experience of diversity, 3) midwifery strategies rooted in diversity, and 4) the legacy for the profession of midwifery. There must be purposeful action by every individual in the profession, as well as the collective voice of midwifery, to identify barriers to inclusiveness and to foster a culture of diversity through respect, recruitment, and mentoring.
Marsden Wagner, a perinatologist and perinatal scientist, is a well known name to midwives and others who advocate for a safer and more responsive maternity health care system. In Born in the USA: How a Broken Maternity System Must be Fixed to Put Women and Children First, Wagner explores and explains the pressures and driving forces within US maternity care systems (and there are many). Effectively interweaving his own experience as a perinatal scientist at the World Health Organization with wider trends in maternity care practices, he makes a powerful case that what should be the highest priority of US maternity care, the woman and her baby, is perilously neglected and of the lowest priority.Wagner grounds his examination of the ways that maternity care in the United States fails to put women and children first in several case studies of practices that have resulted in death and injury. The alarming rise in cesarean section rates, the off-label use of Cytotec to induce or accelerate labor and the resulting damage and death for women and babies, and negative effects of medical management of labor pain reveal that uneven utilization of evidence-based practices and other priorities put women and babies last, with devastating results.The book explores the roles and pressures experienced by players in the multiple forms the US maternity care system currently takes. Rather than a blanket critique of obstetric thinking, Wagner thoughtfully and objectively describes the expectations and demands that obstetricians strive to meet, which often result in care decisions for women in labor that are not medically indicated. These decisions may result in damaging results for women and babies when they prioritize unit efficiency, office and surgery schedules, or personal needs (to get home for dinner). Wagner links these demands to the insular nature of "tribal obstetrics," the fear associated with threats of litigation, and the compelling reticence of physicians to criticize their colleagues' practices and risk damage to obstetrics' professional image and fortunes. His analysis of these perceptions of obstetric practice goes a long way towards explaining how the US maternity care system(s) achieve less than stellar maternal and neonatal outcomes. It also supports his assertion that the system must be changed in order to significantly alter these outcomes.In the chapter "Hunting Witches," Wagner describes how midwives threaten obstetric thinking, and why he thinks US midwives have encountered so much medical resistance. Midwives and others will experience a frisson of affirming recognition as Wagner describes the first birth he attended in a woman's home, and how he witnessed the unadulterated power of a woman taking on this elemental life event.Utilizing several cases where physicians have persecuted midwives of all stripes who have supported women seeking out-of-hospital births, Wagner reveals the real underlying anxiety of physicians-they are deeply unnerved by the autonomy of midwifery practice and women's challenges for co...
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