CHANGING CHILDBIRTH IN THE UNITED-KINGDOM - LESSONS FOR US HEALTH-POLICY

This article examines the process that led to the ''changing childbirt h'' initiative in the United Kingdom and its possible lessons for U.S. health policy making. Changing childbirth involves substantial change s in maternity care policy, including increased independence for midwi ves; greater choice for mothers of birthplace and attendant; and a nar rower, more specialized role for obstetricians. Potential lessons for U.S. health policy include the following points: Even narrow, targeted reform is generally slow to develop, and bureaucracies continue to sh ow ingenuity in delaying their response to initiatives; systematic res earch and control over problem definition powerfully shapes the policy debate tin the United Kingdom the debate focused on normal birth, rat her 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 U nited States) can influence the process.