Wednesday, July 01, 2009

The Shift Has Begun ~ The Time is Now!

The shift has begun. The evidence is proving what many of us have been say for years, decades. The plain bare truth is that the evidence is showing that many health care providers in the maternity health care field are not practicing evidence-based care.
A study published in the British Journal of Obstetrics and Gynecology in April (116(5):626-36) of this year examined the rising induction rates for labor and birth. Researchers (from the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI) searched MEDLINE and the Cochrane Library between 1980 and April 2008 using several terms and combinations, including induction of labour, premature rupture of membranes, post-term pregnancy, preterm prelabour rupture of membranes (PROM), multiple gestation, suspected macrosomia, diabetes, gestational diabetes mellitus, cardiac disease, fetal anomalies, systemic lupus erythematosis, oligohydramnios, alloimmunization, rhesus disease, intrahepatic cholestasis of pregnancy (IHCP), and intrauterine growth restriction (IUGR).
After extensive examination, researchers recommendations for induction of labour for post-term gestation, PROM at term, and premature rupture of membranes near term with pulmonary maturity are supported by the evidence.
Induction for IUGR before term reduces intrauterine fetal death, but increases caesarean deliveries and neonatal deaths. Evidence is insufficient to support induction for women with insulin-requiring diabetes, twin gestation, suspected fetal macrosomia, oligohydramnios, cholestasis of pregnancy, maternal cardiac disease and fetal gastroschisis.
Likewise, a report issued in Evidence Report/Technology Assessment in March of 2009 (176: 1-257) stated the evidence regarding elective induction of labor prior to 41 weeks of gestation is insufficient to draw any conclusion.
And finally, a study published in Pediatrics (June 2009, 123(6):e1064-71.) showed elective cesarean delivery is consistently associated with increased intrapartum and neonatal mortality, risk of admission, and respiratory morbidity compared with planned vaginal delivery and has no advantage over emergency cesarean delivery in terms of mortality. Neonatal morbidities are lower after elective cesarean delivery than emergency cesareans only with term births. Their data provide evidence that elective cesareans should not be performed before term.
To add to this information, a study last month in Obstetrics and Gynecology (113(6):1239-47) demonstrated that even when controlling for confounders, there was an association between primary cesarean delivery and insurance status regardless of hospital type. The cesarean delivery rate of women with private insurance delivering in private hospitals was 30.4% compared with a cesarean rate of 21.2% in Medicaid patients delivering in public hospitals.
The evidence IS clear.
The time is now to be accurate and vocal about the practices that are not evidence-based and are therefore posing possible harm to mothers and babies, to breastfeeding and to new families. Post is on websites, blog it, Twitter it. Disseminate the information...NOW.

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