This article examines the process that led to the “changing childbirth” initiative in the United Kingdom and its possible lessons for U.S. health policy making. Changing childbirth involves substantial changes in maternity care policy, including increased independence for midwives; greater choice for mothers of birthplace and attendant; and a narrower, 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 show ingenuity in delaying their response to initiatives; systematic research and control over problem definition powerfully shapes the policy debate (in the United Kingdom the debate focused on normal birth, rather 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 United States) can influence the process.

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