Resources For Health Professionals 

In the United States and in many countries around the world healthcare professionals, healthcare payers, researchers, families, and advocacy groups are concerned about  the overuse of medical interventions in childbirth, the high rate of cesareans, and their impact on maternal and infant health. In his Foreword to this book, Dr. Charles Mahan writes, "I have been practicing obstetrics and gynecology either from a patient care or public health perspective for over 40 years and have never seen our once-proud specialty in the dire straits that it is now in America. The author of this book carefully and effectively presents the social and scientific evidence that, in one very serious intervention in birth, cesarean section, things have rapidly spun out of control-from the occasionally necessary surgical procedure to one that actually outnumbers vaginal births in some of our hospitals.

Our premature birth rates, stable for over 70 years (while other countries have lowered theirs satisfactorily), have started to rise rapidly this century. This has been especially true of late preterm births, from 35 to 37 completed weeks. This group represents the main reason preterm births are increasing and as this book points out, many of these children have permanent development problems and learning disabilities since they were born before their brains were mature. Our studies in Florida are showing that as much as two-thirds of our increase in late preterm births is associated with the increasing use of cesareans, often without a trial of labor.

Perhaps most alarming is the increase in maternal deaths the past 5 years. Many of these are post-cesarean and due to infection, uncontrolled bleeding and blood clots that travel to the lungs. This is the first trend upward in mothers dying during or after birth that we have seen for over 100 years."

The following is a list of resources from health professionals, healthcare payers, researchers, birth advocates, and their efforts to promote evidence-based care and reduce cesareans.

Charles Mahan, MD. The Perfect Storm or Can We Rescue Normal Birth Before it's Too Late?
Powerpoint Presentation (PDF)

Nicette Jukelevics: Putting Mothers and Babies at Risk: Promoting the Elusive "Cesarean Delivery on Maternal Request."
Article (PDF)
Commentary in Birth: Issues in Perinatal Care - Volume 36 Issue 3 (September 2009)

Nicette Jukelevics and Henci Goer: The Risks of Cesarean Section - A Coalition for Improving Maternity Services Fact Sheet & A Checklist For Expectant Mothers.
Fact Sheet (PDF)                                                

Agency for Healthcare, Research, and Quality (AHRQ): Nearly 1 in 3 Women Have Babies by C-section.

American Academy of Family Physicians: Policy on Trial of Labor after Cesarean 

American College of Nurse Midwives:Research and Education to Decrease Unnecessary Cesarean Sections 

British Columbia Perinatal Health Program: Cesarean Birth Task Force Report, 2008  

California Maternal Quality Care Collaborative: A successful program to reduce inductions and cesareans

Cambridge University Press, Proactive Support of Labor

Campaign to Save North Shore Birth Center, Beverly, Massachusetts

Centers for Disease Control : Healthy People 2010 guidelines for a cesarean rate

Childbirth Connection: Maternity Quality Matters Initiative, Evidence-Based Maternity Care Report, 2008

Childbirth Connection: Listening to Mothers,  National Surveys and Reports

Childbirth Connection: Evidence-Based Maternity Care: What It Is and What It Can Achieve  

Citizens for Midwifery

Coalition for Breech Birth

Coalition for Improving Maternity Services (CIMS): Evidence Basis for the Ten Steps of Mother-Friendly Care

CIMS Mother-Friendly Forum: Latest evidence from leading experts in support of normal birth.

CIMS, Breastfeeding is Pricelss: Links birth interventions and their impact on breastfeeding (PDF)

Commonwealth of Australia: Improving Maternity Services in Australia               (PDF)

European Midwives Association: Position Paper on Sexual and Reproductive Rights (PDF)

Ina May Gaskin, CPM: The Safe Motherhood Quilt Project

Institute for Healthcare Improvement: Reducing Cesarean Section Rates While Maintaining Maternal and Infant Outcomes: Breakthrough Series Guide

International Cesarean Awareness Network: Advocacy for VBAC

International MotherBaby Childbirth Organization 

JOGNN, Editorial by Nancy K. Lowe: The "Authorities" Resolve Against Home Birth 

Lamaze Institute for Normal Birth: Six Care Practices that Support Normal Birth

Marden Wagner, MD, MSPH: Fish Can't See Water-The Need to Humanize Birth

Midwives Alliance of North America: Reforming Maternity Care in America (PDF)

National Birth Policy Coalition and The Big Push for Midwives Campaign

National Institute for Clinical Excellence, UK: Cesarean Section Clinical Guidelines (PDF)

National Institute for Clinical Excellence, UK: Antenatal Care, Full Guidelines (PDF)

Nation Institutes of Health, VBAC Consensus Conference Final Statement, March 2010
NIH Final Statement (PDF)

National Perinatal Association: Position Paper on Midwifery (PDF)

National Perinatal Association: Position Paper, Choice of Birth Setting (PDF)

Normalni Porod: Petition for Improving Maternity Care Services in the Czech Republic 

National Quality Forum: Voluntary Consensus Standards for Perinatal Care

Northern New England Perinatal Quality Improvement Network: VBAC Project

National Quality Forum (NQF): NQF Endorses National Consensus Standards For Perinatal Care
Press Release (PDF)

Ohio Physicians for Midwives

Ottawa Health Research Institute: Ottawa Personal Decision Guide 

Our Bodies Our Selves: Choices in Childbirth, A Statement by Physicians, Midwives, and Women's Health Advocates 

Reducing Infant Mortality 

Royal College of Midwives: Campaign for Normal Birth

Science & Sensibility: Amy Romano, CNM, A Research Blog about Healthy Pregnancy, Birth, and Beyond

Society of Obstetricians and Gynaecologists of Canada: Elective Cesareans Add Risks During Pregnancy

Society of Obstetricians and Gynaecologists of Canada: Guidelines for Vaginal Birth After Previous Cesarean (PDF)

Society of Obstetricians and Gynaecologists of Canada: Rising c-section rates add risks during childbirth (PDF)

Society of Obstetricians and Gynaecologists of Canada: Joint Policy Statement on Normal Birth (PDF)

Spain Ministry of Health and Consumers' Affairs: Strategies for Assistance at Normal Childbirth in the National Health System, 2007 (PDF in English)

UnitedHealthcare Launches Effort To Help Reduce Neonatal Intensive Care Admissions (related to cesareans)
Press Release (PDF)