Thank you for focusing on natural childbirth ("Reclaiming Childbirth," by Shafia M. Monroe, December 2010). As a practicing midwife for the past 20 years in southeastern Pennsylvania, I have observed strides forward: Health-care professionals are not so quick to push epidurals, vacuum extractions, and episiotomies. At the same time, there have been setbacks: C-sections are now done for a variety of reasons, such as inability to wait or anticipated risks not documented with medical data. Some obstetricians view prenatal care given by a midwife as a "risk factor," which shows that there is still a long way to go.
What the author did not address is maternal and neonatal mortality due to substance abuse, domestic abuse, and reluctance to seek care. If we are to seek to bring natural childbirth options to all and increase the likelihood of a positive outcome, these need to be addressed.