Proactive Support of Labor: The Challenge of Normal Childbirth is one of a select few publications aimed at professionals engaged in hospital-based obstetric care that invites the reader to examine their views on the act of childbirth.  This does not mean that there is a lack of publication in the areas of midwifery or any number of other philosophies defining what a “normal” or “natural” childbirth experience should entail.

Instead, this book distills concepts from many of these existing sources and discusses them in the context of clinical issues that arise during the process of labor and delivery.  The focus on general issues is a means of clearly juxtaposing the “standard of care” given at technically based facilities with that given by practitioners not relying on hospital facilities without absolute medical necessity.

There is no doubt that the technical advances in obstetric care over the past century have directly resulted in both victory and defeat in terms of maternal and fetal morbidity and mortality.  It is also obvious that a healthy debate must exist for any further advances to be made possible.  This book in no way puts an end to this debate, but it does give a strong voice to those that would say that obstetric care has become too liberal in the use of medical procedures.

The main advantage that it has in getting its message across to medical professionals, besides being written by an expert panel of obstetricians, is that it presents a middle road between the extremes of care while decidedly remaining in favor of limiting the “medicalization” of childbirth. This aspect definitely makes this book more palatable to those physicians who may perform a large number of cesarean sections and other procedures that feel attacked by other publications written more like manifestos against technological advance rather than tools to facilitate a dialogue.  Another refreshing character of this book is that it goes beyond the cesarean vs. vaginal birth debate.

It emphasizes the interactions of unpleasant environmental stimuli such as that found in understaffed labor and delivery wards with physiological processes that must take place to prepare for and accomplish a successful delivery. The authors propose with good evidence that the “need” for procedures may in fact stem from the inability of natural processes to occur properly in stressful surroundings.  This interaction is also inextricably related to the overwhelming emotional experience of the mother which, while highlighted throughout discussions in this book, too often escapes adequate mention in medically based texts.

Perhaps most importantly the text culminates in a well-designed comprehensive perinatal care plan. The book title namesake program, proactive support of labor, integrates many of the best practices from both technical and natural birth professionals. It is unlikely that any single publication can significantly change daily clinical practice, but Proactive Support of Labor: The Challenge of Normal Childbirth has potential to make substantial improvements.  The thought provoking presentation and relatively unbiased analyses offer excellent opportunities for further discussion.  It should certainly be read by trainees and experienced practitioners from both sides of the debate.

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