[Childbirth: a comprehensive perspective. Approaches in health technology assessment]

Are the routine interventions provided during a normal birth process in a hospital setting evidence-based? The World Health Organisation has developed evidence-based interventions especially for low risk women world-wide. The trained midwife is the most appropriate and cost effective caregiver in normal pregnancy and birth. Obstetrics in the area of conflict between technology, economy and law can turn a normal physiological event into a medical procedure. It leads to unnecessary interventions and to a concentration of large numbers of labouring women in technically well equipped units with concomitant complications. Technological advances create a desire for perfectionism. Different interests must be safeguarded in both medical and legal risk-benefit assessments. The differences in the reimbursement of normal vaginal delivery and sectio are contradictory. Our ways of caring for pregnant and birthing women reflect their societal value. Health Technology Assessment adds to decision making by pointing out and analysing different aspects.