BIRTHRIGHTS: What Every Parent Should Know About Childbirth in Hospitals

A critical, step-by-step examination of medical interventions in labor and delivery--alerting parents to choices and dangers intrinsic to medical management of birth. Inch, a childbirth educator in England, has deftly incorporated the English experience into her discussion without losing sight of the American scene. What she displays is a ""cascade of intervention"": from the onset of labor to management of mother and baby after birth, any medical intervention will probably lead to further medical intervention. (The risks and hazards following induction of labor is one of the clearest cases in point.) Inch progresses from measures commonly taken in the first stage of labor (routine enemas, confinement to bed, withholding nourishment), through ""active management of labor"" (induction is the biggest offender here), to immediate postpartum care; with each intervention, she explains the complications that are likely to arise. The present system, all told, comes out sorely wanting. Fads are as prevalent in medicine as in other circles, and they have more disastrous results--such as unnecessary caesareans following unnecessary fetal monitoring. (""If the best that can be said of electronic fetal monitoring is that it is equivalent to auscultation [use of a stethoscope], perhaps we should be looking more closely at its use, both in terms of unwanted side effects and. . . enormous cost."") Inch is never strident, and her criticisms are both thorough and well-supported. For those seeking specific guidance on the whole range of choices in pregnancy, Simkin's Pregnancy, Childbirth and the Newborn (p. 144) is the standout. This is a fine alert to the issues, and another strong argument for reform.