"A prodigiously researched and well-written account of the influence of business thinking on the practice of medicine. Informative, lively, and insightful."Camilla Stivers, author of Bureau Men, Settlement Women: Constructing Public Administration in the Progressive Era

"This book provides a well-documented counter-analysis to the prevailing models that market and economic considerations did not really begin to shape the structure of health care delivery until after World War II. A fine work of contemporary medical history."Janet Bronstein, professor, University of Alabama at Birmingham School of Public Health

"This is the analysis we've all been waiting forPerkins has put it all together, showing us the historic roots and contemporary consequences of the economic and industrial approach to childbirth. No matter how much you have read in the childbirth literature, you won't fully understand what is happening until you have read this!"Barbara Katz Rothman,

professor of sociology, City University of New York, and author of Recreating Motherhood

Americans at the end of the twentieth century worried that managed care had fundamentally transformed the character of medicine. In The Medical Delivery Business, Barbara Bridgman Perkins uses examples drawn from maternal and infant care to argue that the business approach in medicine is not a new development. Health care reformers throughout the century looked to industrial, corporate, and commercial enterprises as models for the institutions, specialties, and technological strategies that defined modern medicine.

In the case of perinatal care, the business model emphasized specialized over primary care, encouraged the use of surgical and technological procedures, and unnecessarily turned childbirth into an intensive care situation. Active management techniques, for example, encouraged obstetricians to accelerate labor with oxytocin to augment their productivity. Despite the achievements of the childbirth and womens health movement in the 1970s, aggressive medical intervention has remained the birth experience for millions of American women (and their babies) every year.

The Medical Delivery Business challenges the conventional view that a dose of the market is good for medicine. While Perkins is sympathetic to the goals of progressive and feminist reformers, she questions whether their strategies will succeed in making medicine more equitable and effective. She argues that the medical care system itself needs to be fundamentally "re-formed," and the reforms must be based on democracy, caring, and social justice as well as economics.

Barbara Bridgman Perkins is an independent scholar, health care consultant, and one of the original contributors to Our Bodies, Ourselves.