Lectures

How to Make Medical Anthropology Useful to Healthcare Practitioners, Activists, and Policy-Makers: Lessons Learned

Introduction: A Brief Summary of My Medical Anthropological Activist Work

For three generations of practitioners, activists, and policymakers in the fields of childbirth, obstetrics, midwifery, and maternity care, I have served as the international public face of anthropology. Usually as the only anthropologist present, I have given over 1000 presentations at related conferences around the world that have directly influenced many practitioners. My anthropological work has heavily influenced the language and supported the direction of the movements for the humanization of birth in the US, Europe, and particularly Latin America—most especially my writings and presentations on “the technocratic, humanistic, and holistic paradigms of birth and health care” (Davis-Floyd 2001, 2018a), which gave concrete shape and form to the ideological forces birth practitioners face every day. (NB: From here on, all references without specified names are to my own, solo-authored works.)

Of course, there are likely hundreds of paradigms of birth and health care as held by varying kinds of practitioners, from Ayurvedic, chiropractic, naturopathic, and Chinese medicine to varying anthropological perspectives, but such complexity does not serve birth practitioners. My identification and naming of the three primary paradigms, which exert their ideological forces almost everywhere, my clear, non-jargon-laden explication of the 12 tenets of each in comparison to the other—and my presenting them along a spectrum, showing how practitioners can blur their sharp edges—has served hospital practitioners well; my work explains why they can’t change “the system” but can purposely blur its technocratic lines to introduce at least some aspects of humanistic care. You can’t change a paradigm or belief system unless you can recognize it as such.

My medical anthropological work has long answered the fundamental question posed by birth practitioners and activists around the world: why do obstetricians and nurses perform so many unnecessary and non-evidence-based “standard procedures” during labor and birth? My answer has long been, and remains, that these procedures are rituals that enact the core values of the contemporary technocracy, thereby reinforcing and transmitting them to birthing families and to practitioners, and providing a sense of safety to both, as rituals can do so well (1991, 1994, 2003a, 2018b; Davis-Floyd and Laughlin 2016). Thus, as I have long maintained, standard obstetric procedures for birth make cultural, not scientific sense. Thereby freed from the persistent question of “why,” and given terminology to identify the strong ideologies at play, many practitioners in various countries have been able to move from asking why they are taught to practice as they do, to figuring out how to change, as I will describe a bit further below.

In the US, I served for 15 years on the Board of the North American Registry of Midwives (see below). And I have served since 2006 on the Board of the International MotherBaby Childbirth Organization (IMBCO), acting as Lead Editor and wordsmith for two international initiatives for the betterment of birth globally (also described below). My article on the problems with home-to-hospital transfer during labor (2003a) helped to raise awareness of “the trouble with transport”—many homebirth midwives gave that article to their backup hospitals—and ultimately to help to generate US national guidelines to facilitate what I called “smooth” or “seamless”—as opposed to “fractured”—transports. I have been told that many have become medical/reproductive/feminist anthropologists because of my work, while it has inspired others to become midwives or obstetricians. And some anthropologists have become midwives and vice-versa as a result of my work.

This article is based on my personal experiences, on feedback I have received over the years from women, birth activists, and birth practitioners, and on data I have gathered from 84 birth practitioners and researchers about the influence of my work on theirs. The point is not to aggrandize myself, but rather to call attention to how applied medical anthropology can directly and concretely influence and facilitate healthcare practitioners, especially when anthropological jargon is minimized and concepts are presented in understandable ways.

The Beginning

The year is 1983. I am excitedly attending my very first childbirth conference, held by the International Childbirth Education Association (ICEA). I have just started interviewing women about their pregnancy and birth experiences, and am eager to understand the alternative birth movement, as it was then called. To an on-stage panel of experts, I ask my burning question, “How can an anthropologist contribute to the childbirth movement?” The panelists stare at each other blankly, until one finally responds, “I have no idea!” At first I am crushed, but then determination rises within me and I state to myself what soon became my mantra: “As an anthropologist, I will forge my own path in this movement, and I will be of service to it.”

That journey led me to do a great deal of fieldwork and research, and to publish over 80 articles, two single-authored books, two co-authored books, and 14 edited collections. It also led me to be invited to give those 1000 talks around the world, to reach and teach thousands of women and birth-related practitioners. Of course I wanted to build my career in academia, yet I did not wish to speak only to other academics, as so many of us do. I wanted my work to be of practical use to childbearers, and especially to the practitioners who care for them.

At first I just assumed that my work would be useful because it was interesting. Thus I received quite a shock when I first presented my theories on standard obstetric procedures as rituals at a conference in 1985, only to be shot down big time when a childbirth educator said to me, “Well that’s all very interesting, but how can I use it in my classes?” Oops! So from then on, I strove to move my work from “interesting” to helpful. Herein I seek to provide lessons learned along the way to anthropologists and students. I offer these lessons not in a didactic way (except in their titles), but via the lens of my personal experiences and of others’ perceptions of these.

Lessons Learned

Lesson 1. Make Your Work Useful by Speaking Directly to Medical Practitioners in Straightfoward Language, Presenting Clear and Helpful Concepts

The very first response I received to my question to practitioners: “If my work has served you, how?” was from Amy Levi CNM:

I think that your seminal work, Birth as an American Rite of Passage, completely transformed my experience as a midwifery educator. The identification of technocratic v. woman-centered and physiologic birth had a huge impact on how to teach that in a culture that had completely embraced technocratic childbearing. All of your writing has been important to educators who work toward humanizing childbirth.

The 31st response I received was from anthropologist Rea Daellenbach of New Zealand:

Robbie Davis-Floyd’s work on childbirth paradigms and midwifery. . .has been very influential in New Zealand. In the Bachelor of Midwifery programme where I teach, students are introduced to her work early on. One of the cornerstones of midwifery in New Zealand is “cultural safety,” so Davis-Floyd’s article on “rigid vs. fluid thinking” is required reading.

Here Daellenbach refers to my articles (2003c, 2018c) on “Open and Closed Knowledge Systems,” in which I clearly and simply delineate 4 Stages of Cognition first outlined by others, then relate them to what I see as their anthropological counterparts: Stage 1: naïve realism, fundamentalism, fanaticism; Stage 2: ethnocentrism; Stage 3: cultural relativism; Stage 4: global humanism. Daellenbach continued:

To develop culturally safe midwifery practice, students need to reflect on and move beyond ethnocentric thinking. And the distinction Davis-Floyd draws between cultural relativism and global humanism enables students to recognise and respect cultural diversity while also accepting their responsibilities to honor the human rights of childbearing women and to promote optimal health and well-being for these women and their families.

Daellenbach went on to note that my article on the three paradigms is also required reading for NZ midwifery students (as it is for many other midwifery programs), and has been useful for activists everywhere as well. She also said that my work on “intuition as authoritative knowledge” (Davis-Floyd and Davis 1996, 1997) has inspired NZ midwifery students to cultivate and develop trust in their own inner knowings and those of their clients, and I am told it has done the same for many others.  

Lesson 2. Give Talks to and Have Meetings with Practitioners, Keeping in Mind That Every Such Talk You Give Is a Fieldwork Opportunity

Both Daellenbach and a midwife from the Netherlands, Marjolein Faber, commented on the positive effects of my various speaking tours of both countries, during which I gave talks and all-day workshops to midwifery students and the public. I also met with the faculties of their midwifery programs and the leaders of their professional organizations, stressing the importance of constant vigilance to maintain the excellent and fully-integrated midwifery systems of both countries, “impressing us with her deep understanding of our system and sensitizing us to the ever-present dangers presented by the near-global hegemony of the technocratic model of birth,” as Daellenbach noted. Each time I traveled around any country to give invited talks, I worked to understand its maternity care system—I think I should call that “serendipitous ethnography”!

Lesson 3. Publish in Practitioner-Related Journals

Staring in 1986 and to the present, I have published numerous articles in practitioner-oriented journals, including MIDIRS Midwifery Digest, Midwifery Today, the International Journal of Gynecology & Obstetrics, Birth: Issues in Perinatal Care, and the International Journal of Childbirth (see reference section). Obviously, doing so can provide practitioners with information they might not otherwise receive.

Lesson 4. Mentor Practitioners and Help Them Understand Themselves and Their Roles

In my 44th response, Angela Castaneda, anthropologist, doula, and doula researcher, noted that Birth as an American Rite of Passage had helped her to formulate questions surrounding the role that doulas play in birth culture; to understand the birth landscape; and to gain “language to describe the roles that doulas serve as guides navigating technocratic and holistic paradigms. It also helped me think through the rituals that doulas engage in as they move in and out of private and public places and build relationships that traverse families and institutions.” 

My 65th respondee, Paloma Terra, a homebirth midwife in Austin, said that she:

“discovered the vast world of midwifery and birth in technocratic society through your Birth as An American Rite of Passage when I was still in college. . . It was an epiphany!! A true AHA moment!. . .[Later] I decided to become a direct-entry midwife . . .It was under your guidance that I decided to start an apprenticeship with Marimikel Potter. Your article on “The Postmodern Midwife” [2005] and your chapter on “Renegade Midwives” [Davis-Floyd and Johnson 2006a] hit a deep core in me, helping to explain me to myself, as I am both a postmodern and a renegade midwife as you define them! As always, your work helped me make sense of my choices in relation to the lager world around me. . . Throughout time your work and your personal mentorship have helped me find hope, meaning and purpose in my own work.”

Lesson 5. Constructively Build on Practitioners’ Work

My 70th email response was from Suellen Miller, lead author of the frequently cited “Beyond Too Little Too Late [TLTL]/Too Much Too Soon [TSTS]” (Miller et al. 2015); the article addresses over and underutilization of interventions and technologies during labor and birth across differently resourced settings. To Suellen’s naming of the TMTS/TLTL dualism, Missy Cheyney and I (2020a,b) have added the unifying acronym RARTRW—care that is provided in “the right amount at the right time in the right way”; this acronym is rapidly being picked up by others.

Lesson 6. Become an Activist, Join Practitioner Organizations, and Serve on Practitioner and Activist Boards

To explore avenues for professionalizing, the Midwives Alliance of North America (MANA), an organization primarily designed to support midwives who practice out-of-hospital, created the North American Registry of Midwives (NARM). In 1994, I was invited to sit on the NARM Board in the position of Consumer Representative. They felt I could be useful to them, as I had extensively interviewed consumers of birth services, and was already planning a research project on these midwives’ professionalizing efforts. I made clear my desire both to participate in and to study NARM’s process, and they accepted me on those terms. My equal passion for helping to improve the quality of maternity care led me to also serve on the Board of the International Mother Baby Childbirth Organization (IMBCO), since 2006 (described below).

Lesson 7. Help Practitioners with Naming and Policy-Making

Serving NARM

When I joined the NARM Board, its primary purpose was to create and maintain a national certification that would help to professionalize and legalize out-of-hospital practices, and would preserve multiple modes of midwifery training, including the time-honored apprenticeship route. At that time, “lay” midwives were only legal and licensed in a handful of states. Often accused that “anyone can hang up a shingle and call herself a midwife,” they badly needed a professional certification.

It is October of 1994. As a new member of the NARM Board, I am attending a meeting to choose a name for this new certification. Our two choices, based on the certified nurse-midwife acronym “CNM,” are Certified Midwife (CM) and Certified Professional Midwife (CPM). It quickly becomes clear to me that the meeting participants are going to choose CM for its simplicity. I am horrified, but I know I need backup, so I rush to the pay phone to call Barbara Katz Rothman. She completely agrees with me: these midwives should choose CPM to get rid of the stigma of the appellation “lay.”When I explain this to the group, Ina May Gaskin says, “Well, if the two most prominent social scientists of midwifery think we should call ourselves professionals, then that is exactly what we should do.” And instantly, everyone changes their vote to “CPM”—an amazing turnaround, as previously, they had hated the word “professional,” considering it “too exclusionary.” And I think, “OMG, what have I done?”

Yet it worked out well (see 2006a; Davis-Floyd and Johnson 2006). Using “CPM” did enable these formerly lay midwives to generate public understanding of their considerable professional expertise, and helped them greatly to achieve legalization and licensure, to date in 36 states, with laws still pending in others.

My other contributions to NARM included creating their Mission Statement and many hours of helping to craft their How to Become a CPM  manual and other documents and to decide on the criteria for certification and what that process should be. A major intent was to preserve apprenticeship as a viable educational route; to that end, they created a special process:

It is around midnight when I receive a frantic call from two NARM Board members. They need a name for their apprenticeship route; one of their members wants to call it “Portfolio Education Evaluation Process,” which carries the unfortunate acronym “PEEP.” I consider, then suggest PEP—Portfolio Evaluation Process. They are thrilled (as am I), and that process carries the same name today.

Serving the International MotherBaby Childbirth Organization (IMBCO) and the International Federation of Gynecologists and Obstetricians (FIGO)

In my capacity as an IMBCO Board member, I served as co-creator and wordsmith for—and helped to name—the International Childbirth Initiative (ICI): 12 Steps to Safe and Respectful MotherBaby-Family Maternity Care (Lalonde et al. 2019; www.internationalchildbirth.com). The ICI is the result of a merger of two previous international initiatives, one created by IMBCO in 2008 and the other by FIGO in 2015. The ICI Philosophy and 12 Steps constitute a template for optimal maternity care. By now, in an ongoing process, the ICI has been implemented in hundreds of smaller birth practices and in several large hospitals, and endorsed by multiple international organizations—none of which wanted traditional midwives, whom they call “traditional birth attendants” (TBAs), to even be mentioned in the ICI. But my anthropologically-informed perspective on their value to their communities led me to fight (politely) to incorporate them into Step 11 as part of the caregiver continuum—a significant accomplishment, as these organizations are more interested in phasing out “TBAs” than in facilitating their badly needed practices in rural communities where no professional midwives will go (2000, 2018d).

Lesson 8. Mediate!

I believe that anthropologists are well-qualified to mediate disputes, both professional and personal—as we are good at cross-cultural comparison, so are we good at seeing all sides of a story. This is especially true when we have an egalitarian relationship with our interlocutors, as I did during my US fieldwork. Over the years I have successfully mediated multiple conflicts between ACNM and MANA leaders. For one example, in Texas I managed to stop the ongoing battle between CNMs and CPMs over legislation by getting their legislative representatives together to talk; the result was their formation of a joint legislative committee to ensure that their proposed laws would no longer interfere with each other.

And when I studied a Northeastern university-based midwifery educational program, I found that all 15 students in it had bitter complaints about it, yet got punished when they dared to voice these complaints. So with their unanimous permission, I took their issues to the new Program Director, who resolved them all within a few months by firing abusive professors, hiring new, more empathetic ones, and including previously lacking holism and spirituality as central elements of midwifery throughout the program. When I interviewed the next generation of that program’s students, they reported that they were extremely happy with it; no more bitterness or complaints. Anthropologists can make a difference.

Lesson 9. Use Your Work to Positively Influence Practitioners, and Interview Them about Their Major Issues: The Power of the Interview Experience

The Brazilian obstetricians whom my work had inspired said that Birth as an American Rite of Passage had shown them why they needed to change, and that From Doctor to Healer: The Transformative Journey (Davis-Floyd and St John 1998) had shown them how to change, as that book lays out a path that they could follow. Eventually interviewing 32 of them, my colleague Nia Georges and I wrote about their paradigm-shifting processes (Davis-Floyd and Georges 2018). These obstetricians highly valued the interview experience for the chance to tell their stories and feel validated and appreciated for the intense work they had put into accomplishing their paradigm shifts, and to express their frustration at the persecution many were receiving from their technocratic colleagues. For many of our interlocutors, the anthropological interview is a rare chance to feel well and truly heard.

Lesson 13. “Pay It Forward”: Be a Connector and Mentor, Offer Opportunities to Other Scholars, and Foster Research

Because I was privileged to speak at the very first conferences on the humanization of birth held in 10 Latin American countries, I was able to study this movement as I toured those countries and some of their hospitals (witnessing births along the way). That enabled me to “pay it forward” by writing an article on 23 essential steps to humanizing childbirth in Latin America (2007), which was widely used by activists in many countries to further their cause.

Over the years, one of my primary personal tasks has been to connect people with each other whenever needed. For example, Eliza Williamson noted:

“It was through you that I first got in touch with Rodolfo and the folks in Tucumán [Argentina] where I ended up doing Fulbright research between undergrad and grad school, and your scholarly work as well as the [ICI] guidelines helped me flesh out my own research questions. Your personal mentoring since then has helped to shape my research in many important ways (as well as offer a sense of camaraderie in the anthro of repro world!).”

Multiple others have said much the same. And I have taken over 30 interns into my home to work with them, from weeks to months, on whatever they desired. (If you are retired from teaching, as I am, that is a wonderful way to keep on doing it!) My mentoring work has also included organizing numerous AAA sessions to give junior scholars opportunities to present their work, creating 14 lead-edited collections that did the same, and reviewing and carefully editing probably hundreds of articles, theses, and dissertations. I take the review process very seriously, as I myself have suffered from reviews too brief to help and benefited from detailed reviews that helped a great deal.

Lesson 14. Make Your Biases Clear Upfront

In the early years of my work, I was often accused of bias, and that was true: I am heavily biased in favor of the midwifery model of humanistic and holistic care for childbearers, including the presence of doulas. Learning to make those biases clear upfront, both in my talks and my writings, prevented further accusations; given that I had straightforwardly presented my biases, no one could accuse me of having them because I had already said that I did! And of course I have also worked hard to clearly and fairly present the voices and opinions of those I am biased against. For example, in all my writings on US childbearing women, I have made it very clear that the vast majority accept most technocratic ritual interventions because, despite the fact that these interventions harmfully interfere with birth physiology, they make such women feel safe—blessed by the technological kiss. And in my midwifery writings and talks, though I do have a (small) bias toward out-of-hospital/community midwives, I have made every effort to present the standpoints of hospital-based CNMs, who struggle daily to provide humanistic care in a technocratic environment, just as clearly and passionately as I present the standpoints of community-based CPMs. I honor and celebrate all practitioners of the midwifery model of care.

Conclusion

This article has detailed some of the lessons I have learned from my ethnographic research and my multiple anthropological involvements with those whom I have long studied and served. Again, the intent is not to aggrandize myself, but rather to illustrate some of the possibilities for applying medical anthropology to generate positive change—an endeavor in which I trust I have succeeded, and in which I hope to continue to succeed via my current work on the impacts of COVID-19 on maternity care practitioners and childbearers, which I am scheduled to present to a large group of expectant mothers soon. And it is also my hope that the lessons I have learned as presented herein will be useful to other anthropologists who wish to assist the practitioners, activists, and policy-makers whom they study and can potentially serve.

Acknowledgments

I thank Somatosphere and the editors of this Special Issue, Paschal Kum Awah and Elizabeth Durham, for allowing me to narrate some of my anthropologist-as-activist stories and to present lessons learned. I also deeply thank the Wenner-Gren Foundation for their two consecutive research grants #6015 and #6427, which greatly facilitated my midwifery research, and the Foundation for the Advancement of Midwifery, which also has greatly facilitated my work.

Robbie Davis-Floyd PhD, Adjunct Professor, Dept. of Anthropology, Rice University, and Fellow of the Society for Applied Anthropology, is a well-known medical anthropologist, international speaker, and researcher in transformational models in childbirth, midwifery, obstetrics, and reproduction. She is author of over 80 journal articles and 24 encyclopedia articles, and of Birth as an American Rite of Passage (2003) and Ways of Knowing about Birth (2018); co-author of From Doctor to Healer: The Transformative Journey and The Power of Ritual (2016); and lead or co-editor of 15 volumes, the latest of which are Birth in Eight Cultures (2019); Birthing Models on the Human Rights Frontier: Speaking Truth to Power (2021); Sustainable Birth in Disruptive Times (2021); and the solo-edited Birthing Techno-Sapiens: Human-Technology Co-Evolution and the Future of Reproduction (2021). In process is a co-edited Special Issue of Frontiers in Sociology on “The Global Impact of COVID-19 on Maternity Care Practices.” davis-floyd@outlook.com.

References

Cheyney, Melissa and Robbie Davis-Floyd. 2020a,b. “Birth and the Big Bad Wolf: Biocultural Evolution and Human Childbirth,” Part 1 International Journal of Childbirth 09(4):177-192; Part 2, 09(5), in press.

—. 1991. “Ritual in the Hospital: Giving Birth the American Way.” In Anthropology: Contemporary Perspectives, 6th ed, eds. Phillip Whitten and David Hunter. Boston: Whitten and Huntger, 275-285.

—–1994 “The Rituals of American Hospital Birth.” In Conformity and Conflict: Readings in Cultural Anthropology, 8th ed. David McCurdy, ed. New York: HarperCollins, 323-340.  

— 1998a. “Types of Midwifery Training: An Anthropological Overview.” In Getting an Education: Paths to Becoming a Midwife, eds. by Jan Tritten and Joel Southern. Eugene OR: Midwifery Today, 119-133.

—. 1998b. “The Ups, Downs, and Interlinkages of Nurse-and Direct-Entry Midwifery: Status, Practice, and Education.” In Getting an Education: Paths to Becoming a Midwife, eds.  Jan Tritten and Joel Southern. Eugene, OR: Midwifery Today, 67-118.

—. 1999. “Some Thoughts on Bridging the Gap between Nurse and Direct-Entry Midwives.” Midwifery Today 49:15-17.

—. 2000. “Global Issues in Midwifery: Mutual Accommodation or Biomedical Hegemony.” Midwifery Today Int Midwife 53:12-16.

— 2001. “The Technocratic, Humanistic, and Holistic Paradigms of Childbirth.” International Journal of Gynecology & Obstetrics 75:S5-S23.

— 2003a [1992]. Birth as an American Rite of Passage, 2nd ed. Berkeley CA: University of California Press.

—. 2003b. “Home-Birth Emergencies in the US and Mexico: The Trouble with Transport.” Social Science & Medicine 56(9):1911-1931.

——2003c. “Ways of Knowing: Open and Closed Systems,” Midwifery Today 69:9-13. 

*——2005. “Daughter of Time: The Postmodern Midwife.” MIDIRS Midwifery Digest 15(1):32-3

——2006a. “Qualified Commodification: The Creation of the Certified Professional Midwife.” In Mainstreaming Midwives: The Politics of Change, eds. Robbie Davis-Floyd and Christine Barbara Johnson. New Brunswick NJ: Rutgers University Press, 163-204.

—–2007. “Changing Childbirth: The Latin American Example,” Midwifery Today 84:9-13, 64-65.

—. 2018a. “The Technocratic, Humanistic, and Holistic Paradigms of Birth and Health Care.” In Ways of Knowing About Birth: Mothers, Midwives, Medicine, and Birth Activism, by Robbie Davis-Floyd. Long Grove IL: Waveland Press, 3-44.

—-2018b. “The Rituals of Hospital Birth: Enacting and Transmitting the Technocratic Model.” In Ways of Knowing about Birth: Mothers, Midwives, Medicine, and Birth Activism by Robbie Davis-Floyd. Long Grove IL: Waveland Press, 45-70.

—. 2018c. “Open and Closed Knowledge Systems, the 4 Stages of Cognition, and the Cultural Management of Birth.” Frontiers in Sociology 3:23. doi:10.3389/fsoc2018.2018.0023

——2018d. “Mutual Accommodation or Biomedical Hegemony: A Brief Anthropological Overview of Global Issues in Midwifery.” In Ways of Knowing about Birth: Mothers, Midwives, Medicine, and Birth Activism by Robbie Davis-Floyd. Long Grove IL: Waveland Press, 265-282.

——2020. “An Auto-Ethnographic Account of the Creation of the International Childbirth Initiative (ICI): 12 Steps to Safe and Respectful MotherBaby-Family Maternity Care.” In Anthropologies of Global Maternal and Reproductive Health: From Policy Spaces to Sites of Practice, eds. Lauren J. Wallace, Margaret M. MacDonald and Katerini T. Storeng. Springer, in press.

Davis‐Floyd, Robbie, and Elizabeth Davis. 1996. “Intuition as Authoritative Knowledge in Midwifery and Homebirth.” Medical Anthropology Quarterly 10(2):237-269. doi:10.1525/maq.1996.10.2.02a00080.

Davis-Floyd, Robbie E, and Carolyn F. Sargent, eds. 1997. Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives. Berkeley: University of California Press.

Davis-Floyd, Robbie, and Gloria St. John. 1998. From Doctor to Healer: The Transformative Journey. New Brunswick NJ: Rutgers University Press.

Davis-Floyd, Robbie and Christine Barbara Johnson. 2006a. “Renegade Midwives: Assets or Liabilities?” by Robbie Davis-Floyd and Christin Barbara Johnson. In Mainstreaming Midwives: The Politics of Change, eds. Robbie Davis-Floyd and Christine Barbara Johnson. New Brunswick NJ: Rutgers University Press, 447-468.

Davis-Floyd, Robbie, and Christine Barbara Johnson, eds. 2006b. Mainstreaming Midwives: The Politics of Change. New York: Routledge.

Davis-Floyd, Robbie, Debra Pascali Bonaro, Mayri Sagady-Leslie, Helene Vadeboncoeur, Rae Davies, Rodolfo Gomez Ponce de Leon. 2011. “The International MotherBaby Childbirth Initiative: Working to Achieve Optimal Maternity Care Worldwide” International Journal of Childbirth 1(3):196-212.

Davis-Floyd, Robbie, and Charles D. Laughlin. 2016. The Power of Ritual. Brisbane, Australia: Daily Grail Publishing.

Davis-Floyd, Robbie and Eugenia Georges. 2018 “The Paradigm Shift of Humanistic and Holistic Obstetricians: The Good Guys and Girls of Brazil.” In Ways of Knowing about Birth: Mothers, Midwives, Medicine, and Birth Activism by Robbie Davis-Floyd. Long Grove IL: Waveland Press, 141-164.

International Federation of Gynecology and Obstetrics. 2015. “FIGO Guidelines to Mother-Baby Friendly Birthing Facilities.” International Journal of Gynecology and Obstetrics 128(2015):95-99.

Lalonde, André, Kathy Herschderfer, Debra Pascali‐Bonaro, et al. 2019. “The International Childbirth Initiative: 12 Steps to Safe and Respectful MotherBaby–Family Maternity Care.” International Journal of Gynecology & Obstetrics 146(1):65-73.

Miller, Suellen, Edgardo Abalos, Monica Chamillard, et al. 2016. “Beyond Too Little, Too Late and Too Much, Too Soon: A Pathway Towards Evidence-Based, Respectful Maternity Care Worldwide.” Lancet 388(10056):2176-2192.


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