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This title is directed primarily towards health care professionals outside of the United States. This book explores the complex interrelationship between risk and choice in maternity care, taking a close look at how "high" and "low" risk are defined and what impact this has on a woman's ability to exercise informed choices throughout pregnancy. It offers an international collaboration that highlights different perspectives on debated issues, with chapters on maternity care in the UK, United States, Australia, and Ireland contributed by midwives, obstetricians, risk management experts, and sociologists. The aim of this book is to illustrate the changing reality of risk management as it relates to maternity care, and to highlight risk management concerns that may limit the choices available to pregnant women. Clarifies how applications of risk affect the choices pregnant women are able to exercise. Locates pregnancy risk considerations within the overall scheme of risk management. Analyzes practitioners' responses to the requirements of risk management. Presents risk management and choice from the risk manager's perspective, providing an understanding of risk as a "macro concept" in health care. Highlights medico-legal opinions on exercising choice, underscoring the need for accurate information and the ability to make informed decisions. Two chapters examine women's perspectives on risk labeling and the impact this has on choice - one in which the concept of safety within maternity care is discussed, and one in which the views of women with defined risk factors are explored and their ability to make choices is evaluated. Two chapters written by health service risk managers discuss the differences between an inner-city approach and a rural approach to the debate surrounding risk and choice. Discusses midwifery's focus on "normality" in childbirth and considers how this viewpoint affects the risk dialogue, including a chapter on clinical trends in maternity care. An obstetric perspective on risk refutes criticisms of obstetricians as being more likely to impose risk labels and limit choices by discussing how risks and choices are presented and considered within obstetric care. Explores the debate surrounding a woman's right to have a home birth in Ireland, in light of its risk management climate. Two chapters discuss the collaboration between service users, midwives, and obstetricians in Australia regarding the organization and delivery of maternity care, as well as the views concerning risk among indigenous Australians. Perspectives from nurse-midwives in the U.S. discuss the complex relationships among nurse-midwives, obstetricians, and pregnant women with regard to choice, including views on risk within immigrant communities.
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.
Current maternity policy advocates choice and control for women in maternity care, and promotes women as active childbirth consumers and decision-makers. However, evidence that women receive true choice within contemporary maternity services is lacking, and continued and pervasive barriers to choice continue to have profound consequences for many. Choice, Control and Contemporary Childbirth explores the narrative childbirth experiences of a group of women, outlining current policy and providing an overview of the relevant discourses to which women are exposed when making choices for maternity care. This book is unique in presenting narratives that reveal varying identities for women across their maternity exerience, illustrating how maternity choices are simulataneously promised and constrained. It provides practitioners, service providers and policymakers in maternity care, and all those with an interest in birth provision, with profound insights into both women's experiences of childbirth and how choices can be better facilitated in future. 'Maternal choice and control are a challenge in contemporary society, with the changing demography of the population, the rising birth rate and financial constraints. Collecting this diverse information in one publication is timely and an invaluable resource for the practising and academically active midwives, obstetricians and health service managers.' - From the Foreword by Tina Lavender
This book investigates why women choose ‘birth outside the system’ and makes connections between women’s right to choose where they birth and violations of human rights within maternity care systems. Choosing to birth at home can force women out of mainstream maternity care, despite research supporting the safety of this option for low-risk women attended by midwives. When homebirth is not supported as a birthplace option, women will defy mainstream medical advice, and if a midwife is not available, choose either an unregulated careprovider or birth without assistance. This book examines the circumstances and drivers behind why women nevertheless choose homebirth by bringing legal and ethical perspectives together with the latest research on high-risk homebirth (breech and twin births), freebirth, birth with unregulated careproviders and the oppression of midwives who support unorthodox choices. Stories from women who have pursued alternatives in Australia, Europe, Russia, the UK, the US, Canada, the Middle East and India are woven through the research. Insight and practical strategies are shared by doctors, midwives, lawyers, anthropologists, sociologists and psychologists on how to manage the tension between professional obligations and women’s right to bodily autonomy. This book, the first of its kind, is an important contribution to considerations of place of birth and human rights in childbirth.
Optimizing outcomes for women in labor at the global level requires evidence-based guidance of health workers to improve care through appropriate patient selection and use of effective interventions. In this regard, the World Health Organization (WHO) published recommendations for induction of labor in 2011. The goal of the present guideline is to consolidate the guidance for effective interventions that are needed to reduce the global burden of prolonged labor and its consequences. The primary target audience includes health professionals responsible for developing national and local health protocols and policies, as well as obstetricians, midwives, nurses, general medical practitioners, managers of maternal and child health programs, and public health policy-makers in all settings.
Health Insurance is a Family Matter is the third of a series of six reports on the problems of uninsurance in the United Sates and addresses the impact on the family of not having health insurance. The book demonstrates that having one or more uninsured members in a family can have adverse consequences for everyone in the household and that the financial, physical, and emotional well-being of all members of a family may be adversely affected if any family member lacks coverage. It concludes with the finding that uninsured children have worse access to and use fewer health care services than children with insurance, including important preventive services that can have beneficial long-term effects.
Conference proceedings on reassessing the concept of reproductive risk in maternity care and family planning (FP) services cover the following topics: assessment of the history of the concept of reproductive risk, the epidemiology of screening, the implementation of the risk approach in maternity care in Western countries and in poorer countries and in FP, the possible effects on the health care system, costs, and risk benefit calculations. Other risk approaches and ethical considerations are discussed. The conclusions pertain to costs and allocation of resources, information and outreach, objectives, predictive ability, and risk assessment in FP. Recommendations are made. Appendixes include a discussion of issues involved in developing a reproductive risk assessment instrument and scoring system, and the WHO risk approach in maternal and child health and FP. The results show that the application of risk assessment warrants caution and usefulness in service delivery is questionable. The weaknesses and negative effects need further investigation. Risk-based systems tend toward skewed resource allocation. Equal access to care, freedom of choice, and personal autonomy are jeopardized. Risk assessment can accurately predict for a group, but not for individuals. Risk assessment cannot be refined as it is an instrument directed toward probabilities. The risk approach must be evaluated within a functioning health care system. Screening has been important in developed countries, but integration into developing country health care systems may be appropriate only when basic health care is in place and in urban and periurban communities. Recommendations are 1) to prevent problems and detect rather than predict actual complications when no effective maternity care is available; to provide effective care to all women, not just those at high risk; and to provide transportation to adequate facilities for women with complications. 2) All persons attending births should be trained to handle emergencies. 3) Risk assessment has no value unless basic reproductive health services are in place. Cost benefit analysis precludes implementation. Alternative strategies are available to increase contact of women with the health care system, to improve public education strategies, to improve the quality of traditional birth attendants, and to improve the quality of existing services. Women's ideas about what is "risk" and the cost and benefits of a risk-based system to women needs to be solicited. All bad outcomes are not preventable. Copies of this document can be obtained from The Population Council, One Dag Hammarskjold Plaza, NY, NY 10017. Tel: (212) 339-0625, e-mail [email protected].
Over the last hundred years, pregnancy and childbirth has become increasingly safe – yet it is still a site of risk, and a contested ground on which health professionals and pregnant women both face high costs of error. In this context, all those involved in managing pregnancy and birth are expected to identify and mitigate risk: pregnant women are subject to increasing surveillance to ensure the safety of the unborn foetus, and every aspect of childbearing is increasingly medicalised. This publication brings together fascinating social science research to explore the ways in which risk is both created and managed in pregnancy and childbirth. The introductory chapters reflect on the changing social context of childbirth, in particular the medicalisation of both pregnancy and childbirth with development of specialist practitioners, such as obstetricians and midwives who claim to have the knowledge, technology and skills to identify and manage the risks involved. The next three chapters that examine the ways in which women’s behaviour during pregnancy is constructed as potentially risky -- for example smoking, drinking alcohol and taking drugs, and how these risks are monitored and mitigated. The final two parts of the book address the construction of and responses to both medicalisation and risk in childbirth. Altogether, it represents a valuable insight into the complex world of pregnancy, childbirth and risk. This book brings together editorials and articles originally published in special and open issues of Health, Risk and Society.
Fully up to date, this new edition covers all aspects of care for women developing disorders during pregnancy.
"Evidence-based maternity care uses the best available research on the safety and effectiveness of specific practices to help guide maternity care decisions and to facilitate optimal outcomes in mothers and newborns."-- From foreword.