Welcome! I hope you'll hang out and give input. I was in Australia last summer speaking at a couple of conferences and was very impressed with what the grassroots groups were doing to advocate for normal birth. I met many wonderful people and thought the work they and their organizations were doing was brilliant. I was also appalled to find that your cesarean rate is actually higher than ours! This is not a contest you want to win.
As to your question, if you can hang on for another few months, in press is a document to be published by the Coalition for Improving Maternity Services that presents the evidence supporting the Ten Steps to Mother-Friendly Childbirth, a section of the
Mother-Friendly Childbirth Initiative. The MFCI, a consensus statement developed by a coalition of some 25 U.S. childbirth-related organizations and another 25 or so experts in maternity care, establishes appropriate rates for cesarean surgery, vaginal birth after cesarean (VBAC), induction of labor, and episiotomy. It also lists practices that promote safe, effective, satisfying, and cost-effective maternity care. On the CIMS
website, you will also find a
Self-Assessment Tool. It was originally devised to help hospitals and birth centers determine whether they are mother-friendly, but it can also be used by outsiders to evaluate them.
Speaking of evaluation tools, the American College of Nurse Midwives has developed an
Optimality Index, all the elements of which are evidence based. It defines "optimality" as a birth with the best possible outcomes with the least use of medical intervention. The tool gives a simple yes/no score to 50 or so items and incorporates use of medical intervention into the items. It can be used in research as well as for evaluation. Its strength is that unlike almost all conventional obstetric research, it allows
systems of care to be compared.
-- Henci By: Henci Goer