Proactive Support of Labor

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A book was published by the Cambridge University Press earlier this year that I really want to read. Proactive Support of Labor was written by three medical professionals in the Netherlands: Paul Reuwer, an obstetrician and perinatologist; Hein Bruinse, a professor of Clinical Obstetrics; and Arie Franx, a maternal fetal medicine specialist.

The following summary is offered on the book’s web site:

The natural process of birth increasingly involves medical intervention, but the benefits of this trend are questionable at best. The inexorable growth in operative delivery rates is not validated by the tangible improvements in perinatal outcomes. Rather, maternal morbidity has risen significantly. Apart from its physical impact, giving birth is one of the more profound emotional experiences in a woman’s life, but women’s satisfaction with childbirth remains a cause for common concern. Despite all good intentions, modern maternity care is often perceived as professional but impersonal, and labor is not infrequently described as a traumatic or even “dehumanizing” experience. This must be changed.


It was the following paragraphs that hooked me and are making me consider paying forty dollars for a used copy of the book on

Section 1: A wake-up call

To solve the problem, one must first admit that the problem exists and identify its causes. Inconsistencies in care, mismatches between women’s expectations and practice, controversial midwifery and medical services, and unfounded concepts and dogmas on both sides of the aisle will all be identified and discussed in detail, as well as the self-sustaining mechanisms and stubborn nuisance values hampering structural improvements.

The numerous examples of preventable or overtly iatrogenic (provider-caused) birth disorders will be made undeniably apparent and will therefore confront childbirth professionals and even shock lay-readers. The defiant and provocative tone we adopt is by no means to question the integrity and devotion of obstetricians, midwives and labor room nurses, or to belittle their efforts, but to promote debate. We wrote this section to serve as a mirror and an eye-opener, laying bare the fundamental problems plaguing modern childbirth practices all over the world.


This excerpt gives a brief history of the rapid increase of the cesarean section in recent decades.

2.1 The cesarean pandemic

An ideal overall cesarean rate is not known, but on the basis of available databases little noticeable improvement in fetal outcome is observed once cesarean rates rise above 10–15%. In the past decade, however, the cesarean birth rate in all western countries far exceeded these target figures. By 1970, 5.5% of all babies in the USA were delivered through cesarean section. The rate doubled in five years and continued to increase until 1990 when it peaked at 22.7%. It remained stable and even declined slightly through the 1990s before picking up again in 1998. The temporary stabilization in the early 1990s can be explained by campaigns of national health officials and leading obstetricians who sounded the alarm and promoted a trial of vaginal birth after cesarean (VBAC) to avoid routine repeat procedures. However, liability concerns regarding uterine scar-related complications effectively sliced the American VBAC rate to 9.2% in 2004 and the old adage “once a cesarean, always a cesarean” again prevails. Today, one in three American babies is delivered by cesarean section. The rates of perinatal deaths and neonatal cerebral palsy, however, have remained steady over the past decades. The “cesarean problem” that first seemed to be an American affliction is now international. The overall cesarean rates now range between 20% and 30% in most western countries and continue to climb. In the private sector of India and Brazil even more shocking cesarean rates of between 50% and 80% have been reported. Although relatively low in the Netherlands and Scandinavia, the overall cesarean rates in these countries also doubled in the past two decades and their cesarean rates in first pregnancies now exceed 20%.


Has anyone read this book yet? Any thoughts?


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