“…Discussions about the appropriate technology for normal birth ( Chalmers, 1992 ) have raised questions about which standards should be used for benchmarking in maternity care and outcome evaluations in lower risk women. Reviews and reports from Europe, Australia, and New Zealand ( Bastian, Keirse, & Lancaster, 1998;Gulbranson, Hilton, McKay, & Cox, 1997;Woodcock, Read, Moore, Stanley, & Bower, 1990 ), where midwifery practice is an integral component of the health care delivery system, as well as data derived from the few U.S. studies that are available ( Anderson & Greener, 1991;Anderson & Murphy, 1994;Gabay & Wolfe, 1997;Murphy & Fullerton, 1998;Rosenblatt et al, 1997 ) offer compelling evidence that differences in outcomes, when they can be identifi ed in lower risk women, are elements of the process of care. Because of their impact on outcomes, choices made about the process of care must also fi gure in evaluations of clinical practice.…”