Section I: Introduction

Chapter 1: Why This Book? The Failure of Obstetric Management  Read the Chapter

  • Two Contrasting Models: By Their Fruits Ye Shall Know Them
  • Obstetric Management: Broken Promises
  • Obstacles to Change: The Usual and Not-So-Usual Suspects

Chapter 2: Why This Book? The Failure of Obstetric Research

  • Evidence-Based Medicine: the New Dogma
  • The Limitations of Medical Model-Based Research

Chapter 3: About This Book: The Nuts and Bolts  Read the Chapter

  • Our Mini-Review Methods

Section II The Cesarean Epidemic

Chapter 4: The Chase to the Cut

  • A History of the Cesarean Epidemic
  • Rationales for the Cesarean Epidemic: “Round Up the Usual Suspects”
  • “If You Don’t Want to Get Cut, Don’t Go to a Surgeon”
  • What Is Really Driving the Cesarean Rate?
  • Elective Cesarean Surgery: Who Gets to Vote in This Election?
  • The Disinformation Campaign
  • ACOG Ethics: An Exercise in Sophistry

Chapter 5: The Case Against Liberal Use of Cesarean Surgery  Read a Passage

  • Liberal Use of Cesarean: Bad for Mothers
  • Liberal Use of Cesarean: Bad for Babies
  • Liberal Use of Cesarean: The Gift That Keeps on Giving
  • Liberal Use of Cesarean: Anything Good about It?
  • Strategies for Optimal Care
  • Mini-Reviews

Chapter 6: The Case Against Elective Repeat Cesarean  Read a Passage

  • What Are the Tradeoffs Between Planned VBAC and Elective Repeat Surgery?
  • Who Should Labor? . . . Any Woman Who Wants To
  • What Scar Rupture and VBAC Rates Should Be Achievable?
  • What Policies and Practices Produce the Best Outcomes in Women Planning VBAC?
  • Strategies for Optimal Care
  • Mini-Reviews

Section III: Optimal Care for Initiating Labor

Chapter 7: Inducing Labor: Patience Is a Virtue

  • Elective Induction
  • Prophylactic Induction
  • Antenatal Tests: The Emperor Has No Clothes
  • Induction and Cervical Ripening: The Method in the Madness
  • Strategies for Optimal Care
  • Mini-Reviews

Section IV: Optimal Care for Promoting Labor Progress

Chapter 8: Promoting Progress in First-Stage Labor: Yes We Can  Read a Passage

  • The Four Preventive P’s
  • Obstacles to Practicing the Four P’s
  • The Root of the Problem: A Closer Look at Research Principles
  • An Ounce of Prevention is Worth a Pound of Cure
  • Strategies for Optimal Care
  • Mini-Reviews

Chapter 9: Augmentation: Forced Labor

  • Active Management of Labor: Fiction Versus Fact
  • The AMoL Toolbox: The Parts Are No Better Than the Whole
  • Labor Dystocia as State of Mind
  • Strategies for Optimal Care
  • Mini-Reviews

Section V: Optimal Care for Guarding Safety and Wellbeing in Labor

Chapter 10: Electronic Fetal Monitoring (Cardiotocography): Minding the Baby

  • EFM, the Early Years: Self-Interest, 1; Science, 0
  • The Facts About EFM
  • Why Doesn’t EFM Work as Predicted?
  • EFM, the Later Years: Refusal to Face Facts
  • EFM and Conflicts of Interest
  • Why Does Use of Continuous EFM Persist?
  • Is the Routine Use of Continuous EFM Ethical?
  • Strategies for Optimal Care
  • Mini-Reviews

Chapter 11: Routine IVs Versus Oral Intake in Labor:  Read a Passage
“Water, Water Everywhere, Nor Any Drop to Drink”  

  • How Risky Is Oral Intake in Labor?
  • Is There Any Value to Oral Intake?
  • Are IVs an Adequate Replacement for Oral Intake?
  • Why Doesn’t Evidence Change Practice?
  • Strategies for Optimal Care
  • Mini-Reviews

Chapter 12: Epidurals and Combined Spinal-Epidurals:  Read a Passage
The “Cadillacs” of Analgesia  

  • Under the Hood
  • The Great Debates: Do Epidurals Affect Cesarean Delivery? Do They Affect Newborn Behavior?
  • Qui Bono? (Who Benefits?)
  • What Do Women Want?
  • Strategies for Optimal Care
  • Mini-Reviews

Section VI: Optimal Care for Birthing the Baby

Chapter 13: Second-Stage Labor: Lead, Follow, or Get out of the Way?  Read a Passage

  • Giving Birth Versus Being Delivered
  • Critiquing Managed Second Stage: Shortcomings in the Research
  • Glimpses in the Fog: What Can Be Gathered from the Research?
  • Is Physiologic Second Stage Harmful?
  • Clearing the Slate: Optimal Care for Women in Second Stage
  • Strategies for Optimal Care
  • Mini-Reviews

Chapter 14: Instrumental Vaginal Delivery and Fundal Pressure:
When Push Comes to Pull—or Shove

  • A Short History of Instrumental Vaginal Delivery and Fundal Pressure
  • Underlying Unities of the Bipolar Viewpoint
  • The Truth, the Whole Truth, and Nothing But the Truth About Instrumental Delivery and Fundal Pressure
  • Strategies for Optimal Care
  • Mini-Reviews

Chapter 15: Episiotomy: The Unkindest Cut  Read a Passage

  • The Case Against Episiotomy
  • What Do Obstetricians Know and When Did They Know It?
  • Why Hasn’t Episiotomy Withered Away?
  • The “Cut Above”: Déjà Vu All Over Again?
  • Strategies for Optimal Care
  • Mini-Reviews

Section VII: Optimal Care for After the Birth

Chapter 16: Third-Stage Labor Active Management: The Wrong Answer to the Right Question

  • Would Universal Application of Active Management of Third Stage Improve Outcomes?
  • Did Expectant Management Get a Fair Trial?
  • What About Harms?
  • Medical Model Bias and the Triumph of Cognitive Dissonance
  • The Case for a New Approach
  • Strategies for Optimal Care
  • Mini-Reviews

Chapter 17: Newborn Practices: Don’t Just Do Something; Sit There!  Read a Passage

  • Active Management of Newborn Transition: How We Got Here
  • When Intervening Becomes the Norm
  • First, Do No Harm
  • Strategies for Optimal Care
  • Mini-Reviews

Section VIII: Optimal Practice for a Maternity Care System

Chapter 18: Supportive Care in Labor: Mothering the Mother Versus Serving the Doctor

  • Missing in Action: Why Isn’t Supportive Care Part of the Package?
  • Why Isn’t Supportive Care Part of the Package? Effects of the Medical Model
  • Why Isn’t Supportive Care Part of the Package? Effects of the Institutional Social Structure
  • Why Isn’t Supportive Care Part of the Package? The Doula Paradox
  • Harms of the System: “Power Corrupts; Absolute Power Corrupts Absolutely”
  • What Perpetuates This Dysfunctional System?
  • Mini-Reviews

Chapter 19: Midwife-Led Care: Organizing an Optimal Maternity Care System

  • What Constitutes an Optimal Maternity Care System?
  • Midwives: The Optimal Primary Care Providers
  • Is Midwife-Led Care Only for Low-Risk Women?
  • Obstacles to Change
  • Beacons of Hope?
  • Mini-Reviews

Chapter 20: The Place of Birth: Birth Homes  Read a Passage

  • What to Expect in a Birth Center
  • But What About Safety?
  • Better Safe Than Sorry?
  • Are We Asking the Wrong Question?
  • Integrating Birth Centers into a System of Maternity Care
  • Mini-Reviews

Chapter 21: The Place of Birth: Home Births  Read a Passage

  • Beliefs About Safety Among Women Choosing Home Birth
  • Do Women Consider Risks of Home Birth?
  • VBACs and Breeches and Twins, Oh Why?
  • Do We Know if Home Birth is Safe?
  • Mini-Reviews

Appendices

Optimal Care for Protecting Maternal Mental Health: “If Mama Ain’t Happy, Ain’t Nobody Happy”

Optimal Care for Not-So-Optimal Babies

  • The Plus-Sized Baby: What’s the Big Deal?
  • The Malpositioned Baby: Rotation, Rotation, Rotation!
  • The Baby with Meconium Staining: Meconium Happens