Safer Childbirth? A Critical History of Maternity Care
London: Free Association Books, 1998. [Buy it on line!]
"Every now and again a book is published that breaks established moulds of thinking and challenges preconceptions and prejudices. This is such a book." quote by Sheila Kitzinger
1998 saw the fiftieth anniversary of the founding of Britain' s National Health Service. In view of its high cost, the need for changes in the provision of the services it comprised was realised. Doctors were enjoined to concentrate on those treatments which can be shown, not only to be clinically effective, but also cost-effective in that they achieve more satisfactory results than those which are more expensive.
In the field of maternity care, much evidence has by now been compiled on the clinical effectiveness of treatments, but so far no system has been found to require those who provide the service, at any level, to follow the evidence thus established.
The first edition of Safer Childbirth? in 1990 showed that actual results have never supported the widely-held belief that today's reduced rates of death or sickness for mother or child were caused by increased hospitalisation or obstetric interventions, and the second edition in 1995 added the further compelling evidence gathered by the House of Commons Health Committee in their thorough inquiry from 1990-1992 into the maternity services, including the scientific evaluations, by then completed, of obstetric practices. The recommendations of the Parliamentary Report in 1992, followed in 1993 by the Government Report, Changing Childbirth, should have revolutionized the direction of maternity care; mothers, not doctors, should henceforth have the dominant role in deciding what sort of care best served their and their babies' interests. With a foreword by Sheila Kitzinger and a new introduction by the author, this edition of Safer Childbirth? tells how the hopes were dashed that the maternity service would be reformed and become an outstanding example of evidence-based medicine, as it was ready to do.
This important, original work is essential reading, not only for all providers and users of maternity care, but also for students of social policy.
Until her recent retirement Marjorie Tew was a Research Statistician at Nottingham University Medical School, Nottingham,
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Shawn & Jeff Hoover, July 4th 2004