World Meta-Studies of the Interaction between Medical Interventions in Childbirth and Maternal and Baby Health. International Alternatives to Hospital Delivery

Why is Childbirth Still a Business? Why is this Phenomenon Dangerous for all Countries?

We have long wanted to write an article with links to authoritative international studies with a representative sampling (the number of subjects is at least 1000 persons) in the field of pregnancy, childbirth and primal human health. We had such an opportunity in the framework of volunteer cooperation with the experts of our project - midwife Lucy Maratkanova and her husband Kolya Zhharov, who have been running the Russian speaking #BirthFree campaign since 2018, which is a branch of the international movement against obstetric violence Roses Revolution (#StopObstetricViolence) and accompany home births in Parati (Brazil). We sincerely and really thank this extraordinary married couple!♥

The article presents the results of 38 meta-studies (including randomized controlled trials). Some of the research results were taken from the website of the Primal Health Research Center primalhealthresearch.com, created by the world-renowned obstetrician-gynaecologist-humanist Michel Odent.

Paradise lies beneath the feet of your mother.
~ The Prophet Muhammad, Hadith

If you protect physiology from interferences so that
breastfeeding/natural births/… will self-promote, self-protect
and self-support, and so the physiological intrinsic power in the reproduction-evolution-motherhood
processes will not be disempowered and weakened ever!
~ Hilda Garst

Today, up to 98% (!) of women all over the world give birth in hospitals, regardless of how healthy they are (Marian F. MacDorman 2014; Office for National Statistics UK 2017; The Conversation 2019).

Treating pregnancy and childbirth as a disease has become the world norm (Oakley 1984; Inhorn 2006; Jónsdóttir 2012), and a woman in labour has become a priori a patient, an object of medical manipulations, often without notice and the possibility of making decisions about her own health and the health of her child. Society has contributed to the fact that in the minds of a pregnant woman/woman in childbirth/puerperas, “the doctor knows better how to give birth and behave toward the baby!” (Parry 2008).

Currently, it has been proven that medical protocols and the work schedule of Ob/Gyns prevail over the natural rhythms of the birth process (Davis-Floyd 1992; Brodsky 2008), and medical institutions are trying to keep within the framework of existing protocols, which, in turn, are created by medical officials. The emphasis is purely on the physical aspect of childbirth, ignoring the psycho emotional and spiritual components of childbirth (Baylis, F. & Sherwin 2002; Turner 1995).

International Midwifery and the Basic Needs of MotherBaby in Childbirth and the Early Postpartum

Childbirth is both a sexual and excretory process that a priori requires privacy and a sense of security (Gaskin 2011; Odent 2007). The best we can do in the process of giving birth to a healthy woman is to create the conditions under which this process will take place without hindrance.

It is crucially important to know, take into account and protect the basic needs in childbirth and the first 1-3 hours after giving birth (Ehrhardt 2011) for mothers, their relatives, doctors and medical health officers.

What is the Danger in Hospitals (Maternity Hospitals) of All Countries?

• a neglect of the woman’s basic needs during childbirth leads to the inhibition or complete halt of the birth process (Odent 2019, Meghan A. Bohren et al 2015);
• an alien and dangerous bacterial environment for the child (there is no time for the formation of an adaptive microbiome) (Odent 2016; Dunn 2017);
• a set of dangerous routine (usually avalanche, cascading) interventions in the natural process of a healthy woman, such as:
  • birth induction (e.g., pitocin, misoprostol, amniotomy и т. д.) (Gregory 2013; Cochrane Database 2013; Cohain 2013, Miracle in the Heart social project et al. 2016);
  • labour augmentation with the artificial oxytocin (Mansy 2017; Belghiti 2011; Oscarsson 2010);
  • epidural anaesthesia (Buckley 2005; D’Angelo et al 2014; Penuela et al 2019);
  • forceps and vacuum extractor (Bentley et al 2018; Xie et al 2013; Jeon et al 2017);
  • episiotomy (perineum dissection) (Shiono et al 1990; Gün et al 2016);
  • Kristeller maneuver (fundal pressure by pushing on the mother's abdomen during labour) (Habek et al 2008; Moiety et al 2014; Zanconato et al 2014);
  • others.
  causes irreparable harm to the health of MotherBaby at the physical, neurological and immune levels (Peters et al 2018; Gregory 2013; Kero 2002);
• the incredible percentage of Caesarean sections in the world is increasing every year (Wise 2018; O'Neill 2016; Diagram 1):

  Diagram 1

  So, in Brazil today in some states the percentage of Caesarean section reaches 80% (!) (Quadros 2000; Diagram 2):
  

  Diagram 2

• Caesarean section and other unreasonable medical interventions are associated with an increased risk of complications for mother and child compared with natural childbirth (Declercq et al. 2013; Magnus 2011; Mascarello et al 2017; Lavender et al. 2012; Diagram 3):

  Diagram 3

• obstetric violence. This is a true phenomenon that is widespread in the modern world, but often not recognized by doctors and women (Ricoy 2011 website). Types of obstetric violence include insulting, neglecting, restricting movement, separation from the baby, any manipulations carried out without the consent of a woman, etc. Acts of obstetric violence leave an indelible mark of experienced humiliation in a woman's life (Ricoy 2016; WHO 2014; Sánchez 2014);
• a woman who transferred responsibility for her birth to a doctor does not go through the most important transformational process - initiation, transition from girl to woman!

Why is Giving Birth an International Business?

Hospital obstetrics today is a huge business and harms the mental and physical health of women and babies (The Conversation 2019; Indie film/Documentary 2008). Home midwifery has also acquired a shade of elitism (in many countries of the world, home midwifery is illegal, so home (including authentic) midwives put a high price tag on their accompanying births outside the hospital.

There is nothing reprehensible in doing business when all interested parties have equal rights and freedoms, the terms of transactions are transparent, there is no coercion and hiding information, and the goal is mutual satisfaction of desires without prejudice to any of the interested parties.

Childbirth in a hospital is a completely different business: it is based on the interests of the corporate industry (Indie film / Documentary 2008). The risks of medical interventions are hushed up, the natural approach is discredited, and the fear of childbirth is amplified in the minds of women and society, arguing that "the only reasonable option for childbirth" is medical care in a hospital (medical birth). As a result, 98% of all women in labour are forced to make “deals” during childbirth in the hospital (Marian F. MacDorman 2014; Office for National Statistics UK 2017; The Conversation 2019). Then the withdrawal of money is “a matter of technique”!

Routine use of drugs means a constant demand for pharmaceutical products, and the child’s undermined health entails a new demand for drugs and medical services in the future. The routine use of the expensive Caesarean section is extremely profitable for the medical system and entails an increase in the salaries of medical personnel (Vedantam 2013; Currie et al 2013; Blanchard 2018).

At the same time, it is obvious that there is no need to use medical technologies to accompany normal physiological births (Odent 2007; J Perinat Educ 2013; Lothian 2014), while for the management of pathological births and observation of women at high risk, it’s reasonable to use medications and medical technologies.

Not surprisingly, an increasing number of families are looking for healthy alternatives to hospital birth (Scarf 2016; Pray 2013; Morris 2017; Table 1; Diagram 4; Figure 1, Diagram 5):

Table 1

Diagram 4

Figure 1

Diagram 5

Our dear obstetrician-gynaecologist, researcher Michel Odent says that in the modern world, from the perspective of a human primal health, its immune and bacteriological environment, one needs to consider homebirth, and then childbirth in any other place. Homebirth is the preferred birth option for a healthy woman with a normal pregnancy (Olsen 2008; de Jonge et al 2009; Hutton et al 2009; Consensus Statement 2013).

In this regard, birthing centers have appeared in the world since the 1980s, and birthing hotels since the 2010s.

A birthing center (freestanding or hospital affiliated) is a place where a pregnant woman consults and has birth attendance by midwives (only in some states of the USA doctors still work in birhting centers) to organize natural births (childbirth without medical interventions) (Diagram 6):

Diagram 6

The characteristics of the world's existing birth places, as well as the limitations and disadvantages of birthing centers and birthing hotels are presented in Table 2 and recent studies (Stapleton et al 2013; Dekker 2013; Larsen 2016; Outten 2017; Assessment of Birth Settings 2013):

Table 2_1

Table 2_2

Table 2_3

Table 2_4

Michel Odent has repeatedly noted throughout his life in books and seminars that it is preferable to have as less people as possible accompanied in childbirth, ideally one silent professional midwife (Odent 2012), who knows and protects the basic needs of mother and baby in childbirth and early postpartum ("the golden hour"). It has also been proven that in the presence of a professional (including authentic) midwife, who provided the perinatal preparation for childbirth, women easily choose unassisted births (Eisenstein 1988; Vogel 2011; Freeze 2008).

References

Marian F. MacDorman, T.J. Mathews, Eugene Declercq. Trends in Out-of-Hospital Births in the United States, 1990–2012. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Centers for Disease Control and Prevention. National Center for Health Statistics. 2014. Accessed February 7, 2020. https://www.cdc.gov/nchs/data/databriefs/db144.pdf.

Office for National Statistics in UK. Birth characteristics in England and Wales: 2017. Accessed February 6, 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2017.

The Conversation. “Most women give birth in hospital – but it’s got more to do with World War II than health”. 2019. Accessed February 8, 2020. http://theconversation.com/most-women-give-birth-in-hospital-but-its-got-more-to-do-with-world-war-ii-than-health-110647.

Oakley, A. The captured womb: A history of the medical care of pregnant women. 1984. Oxford: Basil Blackwell.

Inhorn, M. C. Defining women’s health: A dozen messages from more than 150 ethnographies. 2006. New York: Berghahn Books. Accessed February 10, 2020. http://www.marciainhorn.com/wp-content/uploads/docs/inhorn-chapter-defining-womens-health.pdf.

Jónsdóttir, Oddný Vala. 2012. “Medicalisation of Childbirth in Western Society: Can Women Resist the Medicalisation of Childbirth?” Reykjavík, Ísland. Accessed February 8, 2020. https://skemman.is/bitstream/1946/11156/1/Mannfr%C3%A6%C3%B0i%20BA%20ritger%C3%B0%20-%20Oddn%C3%BD%20Vala%20J%C3%B3nsd%C3%B3ttir.pdf.

Parry, Diana C. 2008. “We Wanted a Birth Experience, not a Medical Experience”: Exploring Canadian Women's Use of Midwifery”. Health Care for Women International Journal. Volume 29 - Issue 8-9. Accessed February 10, 2020. https://www.tandfonline.com/doi/full/10.1080/07399330802269451.

Davis-Floyd, R. E. Birth as an American rite of passage. 1992. Berkeley: University of California Press

Brodsky, P.L. The Control of Childbirth: Women versus Medicine through the Ages. 2008. North Carolina: McFarland & Company, Inc.

Baylis, F. & Sherwin, S. Judgements of non-compliance in pregnancy. In Ethical Issues in Maternal-Fetal Medicine. 2002. Cambridge: Cambridge University Press

Turner, B. Medical Power and Social Knowledge. 1995. London: SAGE Publications Ltd.

Riordan DV, Selvaraj S, Stark C, Gilbert JS. Perinatal circumstances and risk of offspring suicide: Birth cohort study. Br J Psychiatry. 2006. 189:502-7. Accessed February 7, 2020. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/perinatal-circumstances-and-risk-of-offspring-suicide/8FF78CAC81AC53FF17A0B50A247715E2.

Gaskin Ina May. Birth Matters: A Midwife's Manifesta. 2011. New York: Seven Stories Pressю

Odent M. Primal Health: Understanding the Critical Period between Conception and the First Birthday. 2007. London: Clairview Books.

Ehrhardt, Ruth. 2011. Basic Needs of a Woman in Labor. South Africa: printed by author.

Odent, Michel. 2019. The Future of Homo. London: World Scientific Publishing Co.

Meghan A. Bohren et al. The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med. 2015 Jun; 12(6). Accessed February 10, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488322.

Odent, Michel. 2016. Do we need midwives? London: Pinter & Martin Ltd.

Dunn, Alexis B, Jordan, Sheila, Baker, Brenda J., and Carlson, Nicole S. 2017. “The Maternal Infant Microbiome: Considerations for Labor and Birth”. MCN Am J Matern Child Nurs. Accessed February 9, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5648605/#R50.

Gregory, Simon G., Anthopolos, Rebecca et al. Association of Autism With Induced or Augmented Childbirth in North Carolina Birth Record (1990-1998) and Education Research (1997-2007) Databases. AMA Pediatr. 2013. 167(10):959-966. Accessed February 11, 2020. https://jamanetwork.com/journals/jamapediatrics/fullarticle/1725449.

Smyth, Rebecca, Markham, Carolyn, Dowswel, Therese. Cochrane Database of Systematic Reviews 2013. “Amniotomy for shortening spontaneous labour”. Issue 6. Accessed February 13, 2020. https://www.cochranelibrary.com/es/cdsr/doi/10.1002/14651858.CD006167.pub4/full/es.

Cohain, Judy Slome. 2013. “The less studied effects of Amniotomy”. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 26(17):1687-90. Accessed February 13, 2020. https://www.researchgate.net/publication/258375672_The_less_studied_effects_of_Amniotomy.

Miracle in the Heart social project et al. 2016. Human Rights in Childbirth National Report: UKRAINE. Accessed January 1, 2016. https://en.proestro.com/national-report.

Mansy, Amr. 2017. “Does Labor Augmentation with Oxytocin Increase the Risk of Postpartum Hemorrhage? A Randomized Controlled Trial”. Clinics in Mother and Child Health. November 2017. Accessed February 13, 2020. https://www.longdom.org/open-access/does-labor-augmentation-with-oxytocin-increase-the-risk-of-postpartumhemorrhage-a-randomized-controlled-trial-2090-7214-1000268.pdf.

Belghiti, Jérémie, Kayem, Gilles et al. 2011. Oxytocin during labour and risk of severe postpartum haemorrhage: a population-based, cohort-nested case–control study. BMJ Open. 2011; 1(2). Accessed February 14, 2020. https://bmjopen.bmj.com/content/1/2/e000514.

Oscarsson, Maria E., Amer‐Wåhlin, Isis et al. 2010. Outcome in obstetric care related to oxytocin use. A population‐based study. Acta Obstet Gynecol Scand. Issue 31 December 2010. Accessed February 14, 2020. https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1080/00016340600804530.

Buckley, Sarah J. 2005. "Epidurals: Risks and Concerns for Mother and Baby". Accessed February 14. 2020. https://sarahbuckley.com/epidurals-risks-and-concerns-for-mother-and-baby.

D’Angelo, Robert, Smiley, Richard M. et al. 2014. “Serious Complications Related to Obstetric Anesthesia: The Serious Complication Repository Project of the Society for Obstetric Anesthesia and Perinatology”. Anesthesiology 06 2014, Vol.120. Accessed February 14, 2020. https://anesthesiology.pubs.asahq.org/article.aspx?articleid=1917731.

Penuela, Ivan, Isasi-Nebreda Pilar et al. 2019. “Epidural analgesia and its implications in the maternal health in a low parity community”. BMC Pregnancy and Childbirth. Volume 19, Article number: 52. Accessed February 14, 2020. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2191-0.

Bentley, Jason, Lyell, Deirdre et al. 2018. “Maternal morbidity after forceps vs vacuum assisted delivery - Outcomes from a large state-wide cohort”. American Journal for Obstetrics & Gynecology. Volume 218, Issue 1. Accessed February 14, 2020. https://www.ajog.org/article/S0002-9378(17)31868-9/fulltext.

Xie, Ri-hua, Cao, Huiling et al. 2013. “Occurrence and Predictors of Vacuum and Forceps Used Sequentially for Vaginal Birth”. Journal of Obstetrics and Gynecology Canada. Volume 35, Issue 4. Accessed 14, 2020. https://www.jogc.com/article/S1701-2163(15)30958-0/fulltext.

Jeon, Jihan and Na, Sunghun. 2017. "Vacuum extraction vaginal delivery: current trend and safety". Obstetric and Gynecology Science. Nov; 60(6). Accessed February 14, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5694723.

Shiono P, Klebanoff MA, Carey JC. 1990. “Midline episiotomies: more harm than good?” Obstetrics and Gynecology. Sep. 76 (3 Pt 1). Accessed February 14, 2020. https://europepmc.org/article/med/2183106.

Gün, İsmet, Doğan, Bülent, and Özdamar, Özkan. 2016. “Long- and short-term complications of episiotomy”. Turkish Journal of Obstetrics & Gynecology. Sep; 13(3). Accessed February 14, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558305.

Habek, Dubravko, Vuković Bobić Mirna, and Hrgović, Zlatko. 2008. “Possible feto-maternal clinical risk of the Kristeller’s expression”. Central European Journal of Medicine, 3(2). Accessed February 14, 2020. https://www.degruyter.com/downloadpdf/j/med.2008.3.issue-2/s11536-008-0008-z/s11536-008-0008-z.pdf.

Moiety, Fady M. Shawky Azzam, Amal Z. 2014. “Fundal pressure during the second stage of labor in a tertiary obstetric center: A prospective analysis”. The Journal of Obstetrics and Gynecology research. Jan. Accessed February 14, 2020. https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/jog.12284.

Zanconato, Giovanni, Cavaliere, Elena et al. 2014. “Fundal pressure (Kristeller maneuver) during labor in current obstetric practice: Assessment of prevalence and feto-maternal effects”. Minerva ginecologica 66(2). Accessed february 14, 2020. https://www.researchgate.net/publication/262530379_Fundal_pressure_Kristeller_maneuver_during_labor_in_current_obstetric_practice_Assessment_of_prevalence_and_feto-maternal_effects.

Peters L.L, Thornton C, et al. “The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: A linked data population-based cohort study. Birth”. 2018. Accessed February 8, 2020. https://doi.org/10.1111/birt.12348.

Kero J, Gissler M, Grönlund MM, Kero P, Koskinen P, Hemminki E, Isolauri E. 2002. “Mode of delivery and asthma - is there a connection?” Pediatr Res. 52(1):6-11. Accessed February 13, 2020. https://www.nature.com/articles/pr2002135.

Wise, Jacqui. 2018. “Alarming global rise in caesarean births, figures show.” Accessed June 30, 2019. https://www.bmj.com/content/bmj/363/bmj.k4319.full.pdf.

O'Neill SM, Curran EA et al. 2016. “Birth by Caesarean Section and the Risk of Adult Psychosis: A Population-Based Cohort Study”. Schizophrenia Bulletin, Volume 42, Issue 3. Accessed February 13, 2020. https://doi.org/10.1093/schbul/sbv152.

Quadros, Luis G A. 2000. "Brazilian obstetricians are pressured to perform caesarean sections". BMJ. BMJ. 2000 Apr 15; 320(7241): 1072. Accessed June 5, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117951.

Declercq, Eugene R., Sakala, Carol, Corry, Maureen P., Applebaum, Sandra, Herrlich, Ariel. Report of the Third National U.S. Survey of Women’s Childbearing Experiences. Listening to Mothers III Pregnancy and Birth. New York: Childbirth Connection, 2013. Accessed February 3, 2020. https://www.nationalpartnership.org/our-work/resources/health-care/maternity/listening-to-mothers-iii-pregnancy-and-birth-2013.pdf.

Magnus MC, Haberg SE, et al. 2011. "Delivery by Cesarean section and early childhood respiratory symptoms and disorders: the Norwegian mother and child cohort study". American Journal of Epidemiology, Volume 174, Issue 11. Accessed February 2020. https://academic.oup.com/aje/article/174/11/1275/110481.

Mascarello, Keila Cristina, Horta, Bernardo Lessa, and Silveira, Mariângela Freitas. 2017. “Maternal complications and cesarean section without indication: systematic review and meta-analysis”. Revista de Saude Publica, 51. Accessed February 15, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5697917.

Lavender, Tina, Hofmeyr, G Justus et al. 2012. “Caesarean section for non-medical reasons at term”. Cochrane Database Syst Rev. 2012; 3. Accessed February 15, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171389.

The Roses Revolution. A global movement against obstetric violence. Jesusa's Ricoy website. 2011. Accessed February 15, 2020. https://jesusaricoy.wixsite.com/rosesrevolution.

Ricoy, Jesusa. Online petition. 2016. “End the abuse and disrespect during childbirth”. Accessed February 15, 2020. https://www.change.org/p/high-comissioner-of-human-rights-un-end-the-abuse-and-disrespect-during-birth.

World Health Organization Statement. Prevention and elimination of disrespect and abuse during childbirth. 2014. Accessed February 15, 2020. https://www.who.int/reproductivehealth/topics/maternal_perinatal/statement-childbirth/en.

Sánchez, Silvia Bellón. 2014. “OBSTETRIC VIOLENCE: Medicalization, authority abuse and sexism within Spanish obstetric assistance. A new name for old issues?” Accessed February 15, 2020. https://afar.info/biblio/public/2644.pdf.

Indie film/Documentary. The Business of Being Born. 2008. http://www.thebusinessofbeingborn.com.

Vedantam, Shankar. 2013. “Money May Be Motivating Doctors To Do More C-Sections”. Health News from NPR. Accessed February 15, 2020. https://www.npr.org/sections/health-shots/2013/08/30/216479305/money-may-be-motivating-doctors-to-do-more-c-sections.

Currie, Janet, and MacLeod, W. Bentley. 2013. “Diagnosing Expertise: Human Capital, Decision Making and Performance among Physicians”. National Bureau of Economic Research Working Paper No. 18977. Accessed February 15, 2020. https://www.nber.org/papers/w18977.

Blanchard, Sam. 2018. “Why doctors give caesarean sections: Nearly 70 per cent choose the procedure out of fear of being sued, reveals study”. Mail Online. Accessed February 15, 2020. https://www.dailymail.co.uk/health/article-6011297/Nearly-70-cent-doctors-choose-c-sections-fear-sued-study-finds.html.

Lothian, Judith A. “Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary”. J Perinat Educ. 2014 Fall; 23(4). Accessed February 15, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235054.

Scarf V, Catling C, Viney R, Homer C. 2016. Costing Alternative Birth Settings for Women at Low Risk of Complications: A Systematic Review. PLoS ONE 11(2). Accessed February 15, 2020. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0149463.

Pray, Leslie. An Update on Research Issues in the Assessment of Birth Settings. Workshop Summary. Board on Children, Youth, and Families; Institute of Medicine; National Research Council. Washington (DC): National Academies Press (US); 2013 Sep 23. ISBN-13. Accessed February 15, 2020. https://www.ncbi.nlm.nih.gov/books/NBK201937.

Morris, Rachel. 2017. “A Complete Guide to Your Alternative Birth Options”. The Bump. Accessed February 15, 2020. https://www.thebump.com/a/alternative-birth-options.

Olsen, Ole. “Meta‐analysis of the Safety of Home Birth". Birth Issues in Perinatal Care”. 28 June 2008. Accessed February 15, 2020. https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1523-536X.1997.00004.pp.x.

de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, et al. 2009. “Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births”. BJOG, 10 July 2009. Accessed February 15, 2020. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2009.02175.x.

Hutton EK, Reitsma AH, Kaufman K. “Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study”. 2009. PubMed. Sep; 36(3). Accessed February 15, 2020. https://www.ncbi.nlm.nih.gov/pubmed/19747264.

The Journal of Perinatal Education. “Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by ACNM, MANA, and NACPM”. 2013. Winter; 22(1). Accessed February 15, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647729.

Stapleton SR, Osborne C, Illuzzi J. “Outcomes of care in birth centers: Demonstration of a durable model. Journal of Midwifery and Women's Health”. 2013. Accessed February 15, 2020. http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12003/full.

Dekker, Rebecca. National Birth Center Study II. “Evidence Confirms Birth Centers Provide Top-Notch Care”. American Association of Birth Centers, January 31, 2013. Accessed February 15, 2020. https://www.birthcenters.org/page/NBCSII.

Larsen, Nicolette. 2016. "Birthing Center versus Hospitalized Birth". CrissCross: Vol. 4: Iss. 1, Article 4. Accessed February 14, 2020. http://digitalcommons.iwu.edu/crisscross/vol4/iss1/4.

Outten, Leah. “Comparing Birth Options: The Pros and Cons of Hospital, Birth Center and Home Births”. Big City Moms. September 13, 2017. Accessed February 15, 2020. https://www.bigcitymoms.com/uncategorized/comparing-birth-options-look-pros-cons-hospital-birth-centers-home-births.

An Update on Research Issues in the Assessment of Birth Settings. Workshop Summary. Board on Children, Youth, and Families; Institute of Medicine; National Research Council. Washington (DC): National Academies Press (US); 2013 Sep 23. ISBN-13. Accessed February 15, 2020. https://www.ncbi.nlm.nih.gov/books/NBK201937.

Odent, Michel. "The Doula Phenomenon and Authentic Midwifery: Protection as a Keyword". Midwifery Today, Issue 104, Winter 2012. Accessed February 15, 2020. https://midwiferytoday.com/mt-articles/the-doula-phenomenon-and-authentic-midwifery.

Eisenstein, Mayer. Give Birth At Home with the Home Court Advantage. 1988. United States. Vogel, Lauren. “Do it yourself” births prompt alarm”. CMAJ. 2011. Apr 5; 183(6). Accessed February 15, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071383.

Freeze, Rixa Ann Spencer. “Born free: unassisted childbirth In North America”. 2008. University of Iowa. Iowa Research Online. Accessed February 15, 2020. https://ir.uiowa.edu/etd/202.