When we pull back from the setting to the system, we can begin to envision freestanding birth centers as a point of entry into an integrated maternity care system that efficiently and safely serves the majority of childbearing women within their communities. No matter how fast the pace of the regionalization of maternity care, we will never achieve a system where all women give birth in settings with 24-hour in-house staff and immediate access to surgical facilities. Indeed, there are compelling arguments that we should not attempt to do so. Busier maternity units demand more processing of patients through the system, which leads to fixed limits on the allowable length of labor and builds in incentives to schedule more inductions and cesarean surgeries. In turn, more intervention leads to more unintended adverse effects of intervention and consequently the need for ready access to the means to manage iatrogenic complications. Centralization and medicalization work in concert to further reinforce the medical model view of childbirth as pathological.

Passage from Chapter 20: The Place of Birth: Birth Homes
image credit: The Birth Center, Wilmington, Delaware

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