Hi Everybody:
   I've just been loaned a copy of " Coming to Term...Innovations in Safely
Reducing Cesarean Section Rates" by the Medical Leadership Council. There are
three sections: broadening physician accountability, enlisting the patient,
and restaffing the hospital."
   Some of the members of the review panel include Penny Simkin, Bruce Flamm,
and John Kennel. There are so many wonderful, useful pieces of research and
data in this book. Like the research showing that epidurals (particularly
early ones)are directly correlated with cesareans. And that 20% of cesareans
are influenced by patient demand: 9% from epidural=induced dystocia, and 11%
from patient refusing trial of labor. And that nurse midwives decrease costs,
not cesarean rates. And that "even the toughest plans tolerate high c/section
rates"...this when referring to HMOs.
This stuff has impact on us in our work with mothers and babies. I can't cite
everything, as the report is nearly 200 pages long. Doulas are showed to be
very cost effective, as is a low nurse-patient ratio. Also recommended is the
in-house OB, the one that can be in-house and perform "watchful waiting" and
not lose anything, when contrasted with the office OB who looses time in the
office when mothers are in  labor and therefore has a vested interest in
scheduling deliveries.
   It can be obtained (I don't know if there is a fee) from the Medical
Leadership Council (FAX) 202-672-5700. Phone: 1-800-673-1756. Ask for order
number MLC-000-001. It is intended for broad dissemination among OBs,
administrators and L&D staff.
It is a blockbuster. Warmly, Nikki