1. General introduction

Section 1: A Wake-Up Call

2. Medical excess in normal childbirth

3. Avoidable causes of failed labors

4. Harmful birth care practices

5. Destructive territorial disputes

6. Self-sustaining mechanisms


Section 2: Back to Basics

7. Forgotten lessons from nature

8. Elementary biophysics of birth

9. Definitions and verbal precision

10. First-stage labor revisited

11. Second-stage labor redefined


Section 3: Proactive Support of Labor

12. Leading principles

13. Nulliparous versus parous labor

14. Diagnosis of labor

15. Prevention of long labor

16. Personal attention and support

17. Amniotomy and oxytocin

18. Pre-labor preparation

19. Affective dimensions of labor pain

20. Pain relief re-examined

21. Dynamic dystocia unraveled

22. Obstructed labor

23. Curtailed use of induction

24. Safe care of the fetus

25. Organizational reforms

26. Implementation and ongoing audit cycle

27. External audit of procedures and outcomes


Preface 2nd edition

The central message remains unchanged in the updated Second Edition of this book and continues to emphasize the need for fundamental reforms in the world of obstetrics and midwifery. The policy proposals – aimed at enhancement of women’s satisfaction with the childbirth experience and a safe reduction of the cesarean birth rate – stay the same.

New is the deeply researched treatise on the worrying misapplication of Evidence Based Medicine, leading to false evidence claiming a tempering effect of labor inductions on cesarean rates. Many other prevalent misinterpretations of the literature are exhibited, and several new examples of disturbing misguidance from official guidelines are exposed.   

The chapters on audit and quality control have been rewritten. The clinical procedures and outcomes are now analyzed according to the Robson ten-group classification system, providing the best evidence of the effectiveness and safety of the combined policies and the overall strategy of proactive support of labor.

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