Optimal Care in Childbirth: The Case for a Physiologic Approach

optimal careThis book, the successor to Henci Goer’s Obstetric Myths Versus Research Realities but this time co-authored with Amy Romano, is possibly the most well thought out and planned book that I have read for a long time, and I can only imagine how much work and time went into creating it.  It is worth noting – especially at a time when the word ‘childbirth’ is sometimes used ambiguously – that the book is focused on labour and birth rather than the childbearing journey as a whole, and its fatness gives a clue to the depth in which the authors consider the evidence that relates to this.  Goer and Romano make no bones about their bias towards the physiologic approach mentioned in the title, and analyse the research in numerous areas in order to demonstrate what kinds of approaches offer the best outcomes for women and babies.  (As we know from the recent Cochrane review, midwifery-led approaches give the best outcomes…)

I was initially a little surprised to discover that the authors had decided to begin by looking at caesarean section, leaving home birth until the final chapter, when the usual approach has generally been to begin at the ‘normal’ end of the continuum, but this makes total sense when considering their argument that this is the inevitable result of the policies and practices of the medical model approach.  Goer and Romano take no prisoners as they plough through the different aspects of the medical model and other approaches, providing an array of excellent chapters looking at all kinds of areas including arguments relating to evidence-based practice, specific interventions such as induction of labour and a variety of settings for and approaches to birth.  At times the non-US reader will need to translate into their own context, and there are inevitably sentences that might be phrased differently had they been written with the UK reader in mind, but this is unavoidable when writing for a global market, and making readers think is no bad thing at all.

Some of the best features of the book include the mini-reviews of research relating to a variety of topics which are included throughout. Both these and the lists which the authors have compiled looking at different aspects (both positive and negative) of optimal care are incredibly helpful, perhaps especially for students who may need a starting point for assignments in specific areas, but also for women who are looking for a brief précis of the evidence relating to a particular topic.  The full list of these is included in an appendix, and I suspect that this is the part of the book to which I will be turning to most frequently in the months to come.  Usefulness aside for a moment, what I most enjoyed about this book was the way in which my attention was retained throughout, mainly due to Goer and Romano’s talent for creating pithy titles, clever headings and witty turns of phrase.  A close second is the way in which they have seasoned their text with quotes and other snippets of related information.  The often contradictory quotes – frequently highlighting the illogical nature of the medical model – were a delight to read, and the book is enhanced by the authors’ focus on placing interventions and practices into context; often moving away from the evidence for a few lines here and there in order to explain how or why something came about.

All in, this is a stunning piece of work that is worthy of a place on the bookshelf of anyone interested in childbirth.  Kudos to Henci and Amy for giving us an important and meticulously crafted book written superlatively well. See this book on amazon.co.uk

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