Book Review

Return to Pursuing the Birth Machine Articles by Marsden Wagner The active management of labour Ultrasound: More harm than good? Fish can't see water: The need to humanize birth in Australia

Pursuing the Birth Machine

The search for appropriate birth technology

Marsden Wagner

Marsden Wagner, a former paediatrician working with WHO, believes modern obstetric practice is too interventionist with no proven benefit from such intervention and also that much of this intervention is manufacturer (and therefore dollar) driven.

Such conclusions are based on his extensive international experience as convenor of a number of WHO "Consensus Meetings" on modern childbirth.

Obviously he is well versed on the subject and the book is up to date, well indexed, and with many references although some are from rather obscure sources. The conclusions drawn and presented in the appendices are laudable, serving as an ideal towards which all should aim. In the modern society, Marsden Wagner's book will be very well accepted and will find a place on the bookshelves of most midwives and childbirth educators.

Neil Johnstone
Aust NZ J Obstet Gynaecol, 1995; 35:1; 115

This is a fascinating, challenging and very important book. Marsden Wagner, former director for maternal and child health for the World Health Organisation's Regional Office in Europe, considers the relationship between the medical model of childbirth and the proliferation of technologies which are so often not assessed before coming into routine use.

The book is essential reading for the breadth of its vision, its convinced and convincing support for midwifery care in normal childbirth, and for the work of lay groups in the formation of policy on maternity care. Wagner sees the political activism of such groups as an essential counterbalance to the collaboration between industry and medical professionals. He writes with immense erudition, drawing on the disciplines of literature, sociology, the social sciences, medicine and philosophy in a convincing exposition of the safety of the social model of childbirth. The research literature cited is the most recent. Unlike many scientific texts, this book is beautifully written with a fine command of language, and easy to read despite its length.

Mary Nolan
New Generation Magazine
National Childbirth Trust (UK)
March 1995

The Image of the "Birth Machine" is a particularly apt metaphor for the abundance of untested technology now associated with birth in most of the developed world and aspired to by much of the developing world. There is a careful distinction made between the obstetricians, neonatologists, anaesthetists and midwives who use this technology and the technology itself; it is the latter which is out of hand. This lack of control is due to the perceptions of professionals, in particular the medical model of birth, but also to the hierarchies of policy makers and the short-term, high visibility goals of politicians responsible for implementing policies.

The core of this book is the recommendations of the 3 consensus conferences held by the World Health Organisation (WHO) between 1985-7. The prologue deals not only with the "Birth Machine" itself but also with the way in which the conferences were designed. This emerges as important in helping us to understand the complex issue of owning the research base on which the recommendations were made, acknowledging the gap between knowledge, ideals and practice and realistically considering influencing that gap.

A constant theme is the need to include lay members and user's organisations as a balance for the vested professional interests which usually dominate in areas such as policy making. The author, despite his own professional training as a paediatrician, neonatologist and then epidemiologist, has made a consistent and pleasing effort to minimise medical language, making this book accessible to lay people.

This book moves beyond the sound, research based challenge to clinical practice in the arena of choice and action in relation to policies, whether local, regional or international. It should be read and pondered over not only by those who are part of the "Birth Machine" but also by anybody trying to understand the complex interactions of unfolding events and the human side of policy decision making in the childbirth services.

Katrina Allen, G.P.
MIDIRS Midwifery Digest
September 1994