Changing childbirth” in the United Kingdom: Lessons for US health policy

Abstract This article examines the process that led to the “changing childbirth” initiative in the United Kingdom and its possible lessons for U.S. health policy mak-ing. Changing childbirth involves substantial changes in maternity care policy, including increased independence for midwives; greater choice for mothers of birth-place and attendant; and a narrower, more specialized role for obstetricians. Poten-tial lessons for U.S. health policy include the following points: Even narrow, targeted reform is generally slow to develop, and bureaucracies continue to show ingenuity in delaying their response to initiatives; systematic research and control over prob-lem definition powerfully shapes the policy debate (in the United Kingdom the debate focused on normal birth, rather than on the traditional inquiry into perinatal death); a few well-placed individuals (e.g., female legislators) can bring maternity care issues to the policy agenda; and politically skilled consumer groups (which in the case of maternity care essentially do not exist in the United States) can influence the process. A recent report on maternity care by the Audit Commission, which over-sees the external assessment of the United Kingdom’s National Health Service (NHS), found high levels of satisfaction with maternity care (Audit Commission 1997). It also reaffirmed the principle of woman-centered care developed in the 1993 report entitled Changing Childbirth (Department of Health Expert Maternity Group 1993). Likewise, despite an expectation that the new Labor government would target health pol-This article is a revision of papers presented at the 1991 meeting of the American Public Healt