Trying to raise my kids the best I can

Friday, October 22, 2010

Evidenced Based Practice and Obstetrics

In nursing school they really emphasize the importance of evidenced based practice.  In fact, my essay assignment this week is about evidenced based practice; and by that I mean: practicing medicine based only on what studies have shown to be scientifically sound, as opposed to what tradition has been or what someone respected thinks or says.  This subject always goads me because they all seem so hypocritical.  And granted I'm lumping in every medical professional into this broad stereotype.  More specifically my negativity is towards the obstetrical profession and birth policies of hospitals.  In the defense of the medical profession, they have been a lot more open to non-traditional and Eastern medicine in the past decade. (With some hospitals even offering Reiki to cancer patients). And perhaps this emphasis on evidenced based practice in school is the way that the medical establishment hopes to make that change, via our generation. 

What sorts of evidenced based practice is being ignored in modern obstetric care?  Where to begin?
  • Continuous fetal monitoring is contraindicated by evidence, yet still standard practice.  And I quote from Dr. Laura Riley, the director of labor and delivery at Mass General, in regards to fetal monitoring: “If there’s an embarrassment in medicine, this is it. It’s so ingrained now, and no one has the guts to pull back.” 
  • Eating and drinking during labor.  Still prohibited.  The benefits far outweigh the benefits however.  (The risk asphixiation after an emergency C-Section with general anesthesia).  
  • Letting the mother choose the position during delivery.  Still, for the most part prohibited.  Even though this is purely for obstetrician convenience.
  • Doula's still aren't standard care even though they are a proven pain reduction, and if nothing else, a reduction in medical costs.
  • Water births still prohibited in most (all?) hospitals even though they are proven safe, and like doulas, a proven pain relief and therefore reduced medical cost (less anesthesiologists being employed).
  • C-section rates.  Outrageously high.  No excuses.  Violation of WHO guidelines.  An atrocity on par with third world medical care.  
  • VBAC (Vaginal Birth After Cesarean) still often prohibited even though this is proven safe. (And multiple C-sections are decidedly not safe).
  • Inductions are far too frequent especially in light of the fact that an early induction is dangerous.  
 What it comes down to is two things:
  1. Fear of lawsuits.  This is particularly extreme in the OB specialty because the law says that the lawsuit can occur up to 18 years after the birth and the reparations can include payment for medical services for the damage done to the child for the rest of their life.  
  2. The medical distrust of a woman's body to birth.  This is a vicious cycle in which they don't have trust, they intervene, they convince themselves that the birth would not have been successful without said intervention and the interventions frequently cause the need for interventions!  Not to mention that OB's are trained surgeons.  They're natural instinct is to cut when in doubt. 
  When the obstetric community accepts evidence based practice standards I will stop thinking of medical community as a bunch of hypocrites.  (And this is coming from an RN).  




I recently read that acupuncture is used somewhat successfully in China for C-section anesthesia.  This boggles my mind.  But if science has proved it (which apparently it does) then it must be accepted for the benefit it presents.  Strangely, acupuncture has not been very useful in labor pain. I wonder why it would work for one and not the other.  Too bad it doesn't.  I would be all over that.



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