Birth By Design: Pregnancy, Maternity Care and Midwifery in North America and Europe

This book gives a clear explanation of the differences between the philosophies of midwives and physicians. While midwives see birth as a natural process needing little intervention, physicians view birth as potentially dangerous. Despite the sometimes uncooperative relations between midwives and medical doctors, Rooks explains the profound impact midwives have had on medical practitioners. The influence of midwives has led to the cessation of some medical practices that potentially caused harm to birthing mothers, such as shaving pubic hair and giving enemas to labouring women. Although she recognizes the role of obstetricians in complicated births, Rooks is convinced that midwiferyprovides safe, effective childbirth assistance. She notes, for example, that normal births attended by midwives result in fewer cesarean sections, fewer episiotomies and other expensive interventions. T o ensure appropriate care for birthing women, Rooks suggests that obstetricians and midwives alike assess all birth interventions. Various laws and the need for insurance coverage, as well as the dwindling number of births per thousand in America, provide disincentives for allowing midwives to practice in the United States. Physician supervision of midwives is required and hospital births are advantaged. As a result, it has been difficult for midwifery to gain a foothold in the United States, despite the data from Europe, Canada, Australia, New Zealand, and Japan that strengthens the case for the use of midwives as safe birth attendants.