By: Jackie

Jackie — Tue, 30 Jun 2009 23:56:57 +0000

Rooks and Norsigian hooray! How we need you! That AJOG article raises my hackles. It’s really such disengenuous stuff, that self-congratulation in the last paragrpah of the article. Without any specifics, they attribute their clinical improvements to monumental decreases in maternal and infant mortality “in the last century.” Most of those improvements came from very basic things like the invention of antibiotics, general improvements in public health and nutrition, and the biggest factor–women gaining control of their fertility, having two babies instead of ten, and being able to take advantage of optimal timing of those babies as well. It didn’t come from the medicalization of labor. I hope somehow that the work of Rooks and Norsigian will help OBs get real. In 1945, the US was 6th in maternal mortality, in 1960 or so we were about 12th and now the WHO rates us as 47 of 141 developed countries. Infant mortality has been marginally better, but that’s just because we can keep these little 700 gr babies alive past the neonatal period, so we saw a tiny improvement in 2008. The obstetric profession didn’t even start doing PRCTs on routine obstetric procedures until the ’70s, and as a doula in many a labor room, I see either ignorance of best-evidence protocols or wilfull disregard of caveats that even ACOG publishes, like the words in their own book “Planning Your Pregnancy and Birth” 3rd edition, in 2000, on pages 176-177 ” A large, or even a very large baby is not a medical indication for induction”. How many women will quote those words back to them when warned that their babies were getting too big and they’d better be induced? Is it a woman’s responsibility to have to study the literature to get best-evidence care? Similarly, the lack efficacy of EFM is well known…six or so definitive studies were done back in the late ’90s, and were reassessed in the Lancet in ’96, but every woman still has EFM for every labor, and are never told that intermittant listening is just as good, or better, in that it doesn’t raise the c-section rate. That’s the pesky little attribute of continuous monitoring. Imagine a laboring woman telling her L&D nurse or her OB about the ACOG technical bulletin #207 of July 1995, and getting intermittant monitoring without a fight! The last sentence of the AJOG article says: “Obstetricians are now blessed with lots of data and should make best use of it.” That’s waaaay too lukewarm an invitation to improve practice. Where is the inditement of routine interventions that work best for the convenience of the OB and the hospital, and where is the clarion call to heed the evidence of harm that’s been available for some interventions, like episiotomy, for twenty years? We all know of the travesties large and small. I know of an OB who breaks waters upon admission of her patients, each and every one, no matter where in their labor these women are. When I asked her why she does this, she answered “How will I know if there’s meconium?” Grrrr.

By: Jessica A

Jessica A — Thu, 25 Jun 2009 22:38:09 +0000

2nd what Jill–Unnecesarean said here because I found this extremely important no matter what. This isn’t just for this, but etc in my eyes as well.

By: Jill--Unnecesarean

Jill--Unnecesarean — Thu, 25 Jun 2009 21:52:08 +0000

Go Judy and Judith! Thank you!

Comments on: Norsigian and Rooks on Evidence-Based Labor and Delivery

By: Jackie

By: Jessica A

By: Jill--Unnecesarean