verything goes in cycles in medicine and in health care,

just as in life. Cynthia Gabriel’s new book comes at a fortuitous

“sweet spot,” when obstetric birth practices in the United

States are again changing. As I write this, the American College

of Obstetricians and Gynecologists is liberalizing its statement on

vaginal birth after cesarean delivery (VBAC) with the hope of expanding

the use of VBAC, especially in smaller and rural hospitals, where it

has been largely abandoned.

With fathers now in attendance in operating rooms and extended

families at vaginal births, and with increasing choices for pain relief and

support persons, Natural Hospital Birth will allow for improved collaboration

and negotiation around these choices. It will be very useful not only

to birthing women but also to physicians, nurse-midwives, nurses, health

policy makers, and hospital administrators. The twenty-first century is a

time for collaboration: Midwives, family physicians, obstetric anesthesiologists,

labor nurses, obstetrician-gynecologists, and often high-risk

obstetricians and neonatologists are collaborating in a much more constructive

way than ever before, but they are doing so in an increasingly

medicalized environment. This is the environment where Cynthia

Gabriel focuses the lens for her book.