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13 Health Matrix: Journal of Law-Medicine 325 (2003)


Multiple studies have shown that direct-entry midwifery is just as safe, if not safer than, medical care in low-risk childbirth. Most births using direct-entry midwives require fewer interventions than those attended by physicians, yet yield excellent results. The results of these studies indicate that we should return to midwifery for normal births, rather than continuing to rely primarily on medicine. This option, however, has been significantly curtailed by many state legislatures and courts, despite decades of attempts to make incursions on the traditional paradigm of hospital births attended by obstetricians. As a result, where midwifery is more readily available, it is generally available only from certified nurse-midwives, rather than from direct-entry midwives.

This article considers why the numerous arguments in favor of direct-entry midwifery and against obstetrical management of most pregnancies have generally been unsuccessful, and why the medical paradigm has – at least to date – generally won the day in the legal arena. It also evaluates what will need to change in order to alter the prevailing attitudes towards birth in the United States.