A Swiss childbirth center reports of a dramatic shift in the type childbirth practices performed there in recent years. A new birthing concept was initiated in 1991 due to popular demand by women and couples for a more "natural childbirth" experience.

The new practices consisted of restrictive use of invasive methods, and freedom of choice of different birth methods including waterbirths and other alternative birth methods, but with careful monitoring and birth management remaining in place.

A total of 9,418 births took place at the clinic between 1991, when the new program was introduced, and 1997.

The data relating to various medical interventions were compared to a total of 5,602 births from 1986 to 1990 in the same clinic and to data from a contemporary group from Swiss clinics, a total of 344,328 births from 1986 to 1997.

The authors state that " ... alternative birth methods are very popular" and they note the following trends and statistics:

• The waterbirth rates rose steadily during this period and stabilized at around 40-50% of the total spontaneous births.

• The bedbirth rates account for approximately 40% of the spontaneous births.

• Other birth methods such as standing, supported by a rope, on the mat or on all fours are utilized, but are much less popular and account for the remainder.

• The episiotomy rate dropped from a previous rate greater than 80% to lower than 15%.

• The cesarean section rate in our clinic (around 10%) has remained substantially below the Swiss average (around 15%).

• The rate of the spinal and epidural analgesia was maintained at a constant level, around 13%, while the Swiss average rates doubled and reached 23% in 1997.

The authors conclude that "...natural birth management can be well integrated into the security-oriented way of thinking of classical medicine."

It should be noted that nearly all women giving birth in the region give birth in the clinic without preselection or bias, since it was the only birth clinic in the entire region. The only women referred elsewhere are approximately 2%, which are sent to a larger university-based birth clinic, mostly because of preterm births (before end of the 33rd week).

In a separate article in the same journal, the authors explore more in-depth, their experience with waterbirths. Please see the article addressing this issue in this week's newsletter.

Fetal Diagn Ther 2000;15:283-290.