Optimal Care in Childbirth: The Case for a Physiologic Approach

by Henci Goer

What practices and policies best promote safe, healthy, satisfying labor and birth? What harms do routine or frequent use of tests, procedures, and restrictions introduce? What nonmedical factors drive the current maternity care system? Meticulously documented, Optimal Care in Childbirth: The Case for a Physiologic Approach pulls back the curtain on medical-model management of childbirth.

"This should be a text book for everyone in maternity care!" - Penny Simkin, Co-author of the Labor Progress Handbook.

"This long awaited book is a marvel. It is a 'must have' resource not just for childbirth educators, nurses, obstetricians, and women, but for hospital administrators, insurance companies, and policy makers." - Judith Lothian, PhD, RN

"Goer & Romano have given the maternity care community a gift in their robust examination and synthesis of the evidence supporting best ways to achieve optimal, physiologic birth for women and infants." - Holly Powell Kennedy, PhD, CNM, Varney Professor of Midwifery, Yale School of Nursing

"Optimal Care in Childbirth is a long overdue and very important contribution that will lead to a more safe, sane, and satisfying pregnancy care system." - Steve Calvin, MD, MFM, Co-chair, Human Rights and Health Program, University of Minnesota School of Public Health

Genres: Parenting, Nonfiction

583 pages, Paperback

First published January 1, 2012

About the author

Henci Goer is an award-winning author, research analyst, and advocate for maternity care reform whose work has helped to shape the evidence-based birth movement for more than 40 years. Her commitment began with her own transformative second birth, which revealed how profoundly maternity care practices can affect parents’ physical and emotional well-being for good or ill.

Henci has dedicated her career to closing the gap between research and practice. She is the author of five books, including The Thinking Woman’s Guide to a Better Birth and Optimal Care in Childbirth, and has written more than a hundred articles, guides, and analyses, many of which she shares through her free online Resource Library.

Her latest work, the Take Charge of Your Birth series of books, builds on decades of advocacy—equipping families and birth workers with the clarity, confidence, and evidence needed to make informed, collaborative decisions throughout pregnancy and birth.

Reviews

[Joanna]

This book was a bit of a slow read, honestly, with all of the statistics and such. I think that this book would be excellent as a resource though; If someone questioned me about the safety of some aspect of home birth, or I needed proof to defend my desire to avoid certain interventions, etc. You can tell that Henci Goer and Amy Romano put an incredible amount of effort into searching and sifting through the evidence to present it in a format suitable for people of all backgrounds. I found particular interest in the chapter labeled "The Case Against Elective Repeat Cesarean," because I have a close friend that has had two cesareans for CPD. I do not feel that she was truly given a chance to birth vaginally either time. After her last cesarean, the doctor told her she should not try to give birth vaginally next time (too dangerous), but to just schedule a cesarean. So it was eye opening to read the statistics; regardless of history (including more than one prior cesarean, single-layer uterine closure, low vertical uterine incision, prior preterm cesarean, etc.), 95% or more of women will labor without scar problems.
I also appreciated the data for normal labor duration on pg. 204; They recorded the mean length of first stage (from 4 to 10 cm dilation) in nulliparous women as 7.7 hrs, or approx. 0.8 cm/h. That means that Friedman's calculations for defining abnormal labor (1.2 cm/h) are faster than the mean in normal women! It's so sad that faulty calculations has led to unrealistic expectations placed upon so many women.
I also appreciated the suggestion to try breast stim. before pit, as it is endogenous and passes the blood-brain barrier (pg. 208). The section on how excessive oral intake can cause serious hyponatremia was interesting. I guess that is where drinking electrolyte balanced fluids comes in handy. I suppose that juice may have the same negative effect as glucose IV solutions (if drunk in excess).
I wish that doctors were more well informed about how EFM has not been shown to improve outcomes (except a few less neonatal seizures, possibly caused by augmentation w/ amniotomy) but increases operative delivery rates (pg. 237). And that the likelihood that a fed woman having an intrapartum cesarean under general anesthesia would die of pulmonary aspiration is 3.2 per 10 million (pg. 252). And that women were informed about the down sides of epidurals. The chapter on fundal pressure surprised me; I hadn't ever heard of its use in the U.S., and had thought it was obsolete (except for in 3rd world countries like the Philippines). I was also surprised to read that fundal pressure is not efficacious; if it doesn't work, why has it survived? I've always assumed fundal pressure, like episiotomy, probably got the baby out sooner, but was too dangerous for the benefits to outweigh the risks. I was shocked to read that the episiotomy rate was still 25% in 2004, and that 3/4 of women were not asked for consent (pg. 354).
Their explanation of the difference between midwifery care and midwife-led care was enlightening. It now makes sense to me why midwife-led care is superior, regardless of risk status. I sincerely hope that the United States will be able to follow the example of the other modern nations, and integrate midwifery in such a way that a midwife may consult, collaborate, or refer to physicians or other specialists as needed. Until we learn to work together, neither doctors by themselves, nor the midwives by themselves will be able to give women what has proven to be best practice.

[Hannah · Rating 4 out of 5]

A required read for my last semester of midwifery school. I was pretty enamored with this when I first picked it up - and I do refer back to it all the time. It's a great compilation of evidence based information on relevant clinical topics - with a smattering of the rah rah midwifery stuff.

[Molly · Rating 4 out of 5]

Very thorough and very useful. It is technical and precise and I had to look up quite a few of those technical words, but it is a necessary contribution to childbirth literature. It really opened my eyes to what a complex subject this is and how difficult it is to get a true understanding of best practice because there are SO MANY variables. But they also make it clear that birth has the best outcomes when mothers and babies are cared for in their whole person. Women are not just birth machines or an obstacle to be overcome in getting the baby out and caring for their emotions and comfort is part of achieving a successful birth. It opened my eyes to how money drives modern obstetrics and how often the doctor has become the center of the birth and it is he who achieves the delivery in spite of the mother rather than centering on the mother and her needs to help her birth her baby. I also appreciated the advice given at the end of each chapter for how to achieve optimal results naturally and which few circumstances can benefit from interventions.

[Penny Lane · Rating 5 out of 5]

Great read! Thumbs up in every aspect of this book.

[Jessica Tiderman · Rating 5 out of 5]

Though it may be a boring read for people who aren't into statistics, this is a fantastic guide through obstetric care in the US. It shows what is helpful and what is necessary.