women's health worldwide
Royal College of Obstetricians and Gynaecologists guidelines: How evidence-based are they?
Prusova, K., Tyler A., Churcher L., Lokugamage A. U.
Journal of Obstetrics and Gynaecology, 2014; Early Online: 1-6
A much needed study by Amali Lokugamage and colleagues analysing 1,682 obstetric and gynaenecological recommendations in a total of 52 practice guidelines in lieu of the scientific evidence they are based on. They authors conclude that only 9-12% are indeed based on grade A scientific evidence and since 2007 even more likely to be based on clinical experience alone. The authors provide powerful evidence that we cannot assume recommended obstetric or gynaecological procedures are based on high quality scientific evidence. The discussion is a MUST READ.
PDF is available here
Evidence Based Medicine: a movement in crisis?
Greenhalgh T, Howick J & Maskrey N.
British Medical Journal 2014 June 13th: 348:g3725.
The authors argue that albeit the obvious positive benefits of 'evidence-based' medicine it has also had negative effects. They state for instance that vested interests by drug and medical devices industries have misappropriated the quality mark. A very important article and call for a return to ethical care as the top priority of evidence–based medicine.
Scientific Evidence Underlying the American College of Obstetricians and Gynecologists'
Practice Bulletins Wright, J.D., MD, Pawar, N., MD, Gonzalez, J.S.R.,MD, Lewin, S.N., MD, Burke, W.M., MD, Simpson, L.L., MD, Charles, A.S., MS, D'Alton, M.E., MD, and Herzog, T.J MD.
American College of Obstertricians and Gynecologists 2011 Sept; Vol.118, No.3
Another pertinent study where the authors conclude that only "One third of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence.
PDF is available here
Older but equally relevant
The obstetrical and postpartum benefits of continuous support during childbirth
Scott, KD., Klaus, PH., & Klaus, MH.
Journal of Women's Health Gender Based Medicine 1999 Dec., 8(10), pp.1257-64.
Three meta analyses of 12 randomised controlled trials clearly demonstrating the highly significant positive impact of doulas on obstetrical and postpartum outcome. The authors write: "The results of these 12 trials strongly suggest that doula support is an essential component of childbirth. A thorough reorganization of current birth practices is in order to ensure that every woman has access to continuous emotional and physical support during labor".
The doula: an essential ingredient of childbirth rediscovered.
Klaus, MH. & Kennell, JH.
Acta Paediatrica 1997 Oct., 86(10), pp.1034–36.
A study providing strong evidence about the beneficial effects of the presence of doulas at birth for not only the mother & baby but also the father.
Continuous emotional support during labor in a US hospital:
A randomized controlled trial.
Kennell, JH., Klaus, MH., McGrath, S., Robertson, S. & Hinkley, C.
Journal of the American Medical Association 1991 May 1st , 265(17), pp.2197-201.
A randomised controlled trial providing clear evidence about the beneficial effects of doulas. The presence of a doula significantly reduces forceps deliveries and c-section rates. The authors wrote: "The beneficial effects of labor support underscore the need for a review of current obstetric practices."
Effects of social support during parturition on maternal and infant morbidity.
Klaus MH, Kennell JH, Robertson SS, Sosa R.
British Medical Journal 1986 September 6th; 293:585–587.
The authors write: "this study suggests that constant human support may be of great benefit to women in labour.
Birthplace Cohort Study
The evidence of the safety of home-births in second or subsequent births. Clear evidence that births in midwifery units have significantly fewer interventions, including substantially fewer intrapartum caesarean sections, and more ‘normal births’ than births in an obstetric unit.
British Medical Journal (BMJ)
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