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Study: Two-Thirds of OB-GYN Clinical Guidelines Have No Basis in Science

PushNews from The Big Push for Midwives Campaign
CONTACT: Katherine Prown, (414) 550-8025, katie@pushformidwives.org
FOR IMMEDIATE RELEASE: August 15, 2011
Study: Two-Thirds of OB-GYN Clinical Guidelines Have No Basis in Science
Majority of ACOG Recommendations for Patient Care Found to Be Based on Opinion and Inconsistent Evidence
WASHINGTON, D.C. (August 15, 2011)—A study published this month in Obstetrics & Gynecology, the journal of the American College of Obstetricians and Gynecologists, found that barely one-third of the organization’s clinical guidelines for OB/GYN practice meet the Level A standard of “good and consistent scientific evidence.” The authors of the study found instead that the majority of ACOG recommendations for patient care rank at Levels B and C, based on research that relies on “limited or inconsistent evidence” and on “expert opinion,” both of which are known to be inadequate predictors of safety or efficacy.

“The fact that so few of the guidelines that govern routine OB/GYN care in this country are supported by solid scientific evidence—and worse, are far more likely to be based on anecdote and opinion—is a sobering reminder that our maternity care system is in urgent need of reform,” said Katherine Prown, PhD, Campaign Manager of The Big Push for Midwives. “As the authors of the study remind us, guidelines are only as good as the evidence that supports them.”

ACOG Practice Bulletin No. 22 on the management of fetal macrosomia—infants weighing roughly 8 ½ lbs or more at birth—illustrates the possible risks to mothers and babies of relying on unscientific clinical guidelines. The only Level A evidence-based recommendation on the delivery of large-sized babies the Bulletin makes is to caution providers that the methods for detection are imprecise and unreliable. Yet at the same time, the Bulletin makes a Level C opinion-based recommendation that, despite the lack of a reliable diagnosis, women with “suspected” large babies should be offered potentially unnecessary cesarean sections as a precaution, putting mothers at risk of surgical complications and babies at risk of being born too early.

“It’s no wonder that the cesarean rate is going through the roof and women are seeking alternatives to hospital-based OB/GYN care in unprecedented numbers,” said Susan M. Jenkins, Legal Counsel of The Big Push for Midwives. “ACOG’s very own recommendations give its members permission to follow opinion-based practice guidelines that have far more to do with avoiding litigation than with adhering to scientific, evidence-based principles about what’s best for mothers and babies.”

The Big Push for Midwives Campaign represents tens of thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push for Midwives is to educate state and national policymakers and the general public about the reduced costs and improved outcomes associated with out-of-hospital maternity care and to advocate for expanding access to the services of Certified Professional Midwives, who are specially trained to provide it.

Media inquiries: Katherine Prown (414) 550-8025, katie@pushformidwives.org

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4 comments to Study: Two-Thirds of OB-GYN Clinical Guidelines Have No Basis in Science

  • This is why couples have to be educated in discerning true health concerns vs. arbitrary guidelines. It can be very tricky for parents to figure out especially when emotions are so high at the end of pregnancy or during labor itself. I always teach couples to start with the first question: Is mom ok? Baby ok? If mom and baby are ok then mom and baby are ok! Then we go to the next question: Could this be normal? There is a wide range of normal and yet more and more women are being “managed” who fall outside of increasingly narrow guidelines. Case in point, it is very difficult anymore to find an OB in this area who won’t push hard for an induction past 41 weeks. The induction pressure begins about 3 days past due. By the time mom is 7 days past due she is fully expected to be induced. It takes a couple who is willing to advocate and potentially even sign the Against Medical Advice form to go beyond this time-frame and let baby come on his own timing.

  • Amanda

    We just recently had a similar experience to what was referenced above regarding pressure to induce. Our third baby was being monitored with non-stress tests and ultrasound showed a healthy looking placenta and good levels of fluid, yet my midwife, who works in a practice with doctors, was suggesting induction after 41 weeks and insisting after 42 weeks. We ended up finding a home-birth midwife who met with us and transferred care to her and had a lovely home-birth at her house at 42 weeks and 2 days. My husband and I did not see the logic in inducing when all evidence showed that things were perfectly healthy and just not quite ready for delivery. We were so thankful for the midwife who ended up overseeing our birth. We couldn’t have asked for a better experience!

  • Many doctors in my area start pressuring for induction before 40 weeks. It can be so hard for the mama to stand firm at the end of her pregnancy!

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