Ethics and “Normal Birth”

The concept of “normal birth” has been promoted as ideal by several international organizations, although debate about its meaning is ongoing. In this article, I examine the concept of normalcy to explore its ethical implications and raise a trio of concerns. First, in its emphasis on nonuse of technology as a goal, the concept of normalcy may marginalize women for whom medical intervention is necessary or beneficial. Second, in its emphasis on birth as a socially meaningful event, the mantra of normalcy may unintentionally avert attention to meaning in medically complicated births. Third, the emphasis on birth as a normal and healthy event may be a contributor to the long‐standing tolerance for the dearth of evidence guiding the treatment of illness during pregnancy and the failure to responsibly and productively engage pregnant women in health research. Given these concerns, it is worth debating not just what “normal birth” means, but whether the term as an ideal earns its keep. (BIRTH 39:4 December 2012)     

Women as Consumers of Maternity Care: Measuring “Satisfaction” or “Dissatisfaction”?

ABSTRACT: The measurement of “satisfaction” has been intrinsic to the models of evaluation of health care. However, a thoughtful approach to its use has not always been evident in which this concept is understood to represent a complex group of theoretical constructs involving attitudes, expectations, and perceptions that may be both positive and critical. These constructs require investigation and evaluation using recognized and developed methodologies. At the same time the importance of listening to patients and to women and their partners in evaluating and carrying out research on maternity care cannot be underestimated if the instruments used are to have construct and face validity. Qualitative data of this kind have a dual function of contributing to a more complex picture of women’s experience and of suggesting that researchers need to explore the issues related to “dissatisfaction” at least as much as those arising from a positive overall view of care. (BIRTH 35:1 March 2008)     

THE MYTH OF “NATURAL” CHILDBIRTH

This paper has summarized a sampling of observations by many social scientists and physicians who have viewed the practices of people in traditional cultures. There has been no intent to point out what is natural or ideal. Rather, it is hoped that the examples of practices different than our own will emphasize the varied ways in which the birthing and feeding processes have been approached. Today we need to make use of the contributions of social science and history to see our own traditions and rituals in context and be open to explore new and old avenues for mothers, fathers, and babies at the time of birth.     

“Physiologic” Jaundice of the Newborn

ABSTRACT: Bilirubin metabolism is reviewed and neonatal jaundice of various types is described. The need for quick, accurate tests for unbound, unconjugated bilirubin is discussed in relation to new suggestions that lower levels of this specific portion of bilirubin may cause damage in the newborn The benefits and risks of present treatments are evaluated.     

Progesterone and Preterm: Seventy Years of“Déjà Vu” or “Still To Be Seen”?

Abstract: Progestogens for the prevention of preterm birth have a long history. In 2003, two widely publicized double‐blind trials, one of daily vaginal progesterone suppositories and the other of weekly intramuscular injections of 17alpha‐hydroxyprogesterone, claimed that the treatments effectively reduce the incidence of preterm birth in women at risk of spontaneous preterm labor. Critical analysis of the reports provides no convincing evidence that either one of these treatments is worth pursuing outside the context of controlled research to determine, first, whether and, second, how the treatments might work.