Thank you, Diana Mason, for the excellent February editorial, "Bad Birthing." I am sharing the information with friends, family, colleagues, and my childbirth preparation class instructor. I recently gave birth to my first child and was struck by how little breastfeeding education and support I received. I hired a lactation consultant. Her education and care saved the day!!

Corinna Mayer, BSN, RN

West Hartford, CT

My classmates and I have been discussing this topic in our class on professional issues in midwifery. What happened to family-centered care based on midwifery's model of "being with women"? In returning to school to become a certified nurse midwife, I was disappointed to learn that our standard of care is based on a medical model fearful of litigation, one that results in families being subjected to recommended tests and procedures that are mandated standards of care. We have gone backward in supporting and respecting pregnant women and their families. Instead of acting as advocates for families, some nurses subscribe to the paternalistic medical model and treat patients as if they have no say in their care. The midwifery model of care should be known and supported by all who provide antepartum, intrapartum, or postpartum care. In the United States midwifery is viewed only as advanced nursing. In other countries, it's considered part of general nursing. I hope nurses will take Diana Mason's suggestion and take the lead in creating interdisciplinary teams to review evidence-based practices in maternity care so that they can empower their patients and themselves.

Michele Baqi-Aziz, MS, FNP, RN, CNS

Lawnside, NJ

Thanks to Diana Mason for so articulately communicating the evidence from Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences (LTM II), which indicates that maternity practices in the United States aren't evidence based. Interventions steeped in the medical model, such as electronic fetal monitoring, have not been shown to improve outcomes, safety, or quality of care. Despite a significant body of literature identifying best practices in normal labor and delivery, many who care for birthing mothers and babies are still not using these practices. Five of the criteria in LTM II were based on the care practices of Lamaze International, adapted from the World Health Organization. Only 2% of the women surveyed reported that all five practices were performed. Lamaze International supports one additional practice that could not be measured. These practices, as found at http://www.lamaze.org, are "labor begins on its own," "freedom of movement throughout labor," "continuous labor support," "no routine interventions," "nonsupine (for example, upright or side-lying) positions for birth," and "no separation of mother and baby after birth with unlimited opportunity for breastfeeding."

Based on the results of LTM II, there is a significant gap between evidence-based practice and the care we currently provide. We need effective, practical, and creative strategies to adopt and implement evidence-based practices. Midwives, nurses, physicians, and administrators must collaborate to identify practices harmful to women and babies and replace them with evidence-based practices that promote, support, and protect them.

Jeannette Crenshaw, MSN, RN, LCCE, IBCLC

Washington, DC