When I walked out of my first prenatal with a homebirth midwife, I knew this was something to which everyone should have access. I wanted to find a way to make midwifery care more accessible to the Northern Neck of Virginia. It would be a big task, as the area presents special challenges. The only hospital on the Northern Neck closed its labor and delivery unit in 2004. A standalone birth center opened in 2010, but closed the next year due to financial challenges.

An obstetric nurse shares her maneuvers for helping to get a baby’s head out of the mother’s bladder compartment and into the pelvic compartment, then facilitating rotation from an occiput posterior position to an occiput anterior or occiput transverse position, saving the mother many hours of hard, ineffective labor and avoiding the need for a c-section.

More than 20 years of efforts by maternal child health care workers has paid off with the news that pregnancy- and childbirth-related deaths worldwide have decreased substantially since the Safe Motherhood Initiative began more than 20 years ago. This information comes from an in-depth study led by researchers from the University of Washington in Seattle and published in The Lancet (1) earlier this year. Generous funding by the Bill and Melinda Gates Foundation allowed them to search out and include in their analysis data that had not been used in previous maternal mortality estimates, achieving more complete and accurate results.

Although many women experience coercive and traumatic hospital births, others fully trust their OB/GYN and prefer to birth in a clinical setting. Women must choose their allies in birth carefully while remaining mindful that castigating all OB care providers does a great disservice to those medical professionals who observe and respect human and childbirth rights.