Evidence-based change: can powerful professional interests be persuaded to do it?

摘要

Midwifery care needs to be integrated into the system of care for women and childbearing families in the United States The evidence has been before us since those first studies of midwifery care by the Frontier Nursing Service in Kentucky and Maternity Center Association in New York City more than 80 years ago. The research on the effectiveness and safety of midwifery care provided in every setting, and in every population, is irrefutable. Yet its implementation is still resisted at every turn. Why? Why is it that "midwife," a word that simply means being "with woman" is so contentious in our society? We midwives are really not a bad lot of folks when you get to know us. I don't have the answer to "why," but I do feel that if we don't begin to make a paradigm shift in the ratio of obstetricians to midwives in the delivery of care to childbearing women and families in the United States, we will not fix the health care system. I will make three points on how to make this paradigm shift.