Comments for Science & Sensibility

Comment on Shake it up: Why we need research and activism to change maternity care by Kathi Wilson

Kathi Wilson — Thu, 29 Jul 2010 19:14:29 +0000

Thanks, Henci, for this list. Anyone who believes that “obstetricians follow the evidence” should do an environmental scan of practices across the country (even Canada) to see the wide variation in routine practices that exists. If they are all following the evidence, why is this so?

An analogue between physiologic birth and creationism is odd, indeed, as it implies that the former doesn’t really exist. As for the purpose of the conference, there is little money to be made from physiologic birth, and it’s hard to get funding for research from which there is little financial gain. I go to obstetrical conferences, too, and although there is some useful learning and research presented there which I appreciate, there are also “research” presentations from industry which has the sole purpose of promoting the product. Follow the money….

Comment on Shake it up: Why we need research and activism to change maternity care by Melissa

Melissa — Thu, 29 Jul 2010 14:25:01 +0000

“Science does contribute to policy and practice but the link is neither consensual, graceful, or self evident.

Love that tweet.

Comment on Shake it up: Why we need research and activism to change maternity care by Suzanne Wertman

Suzanne Wertman — Thu, 29 Jul 2010 12:45:45 +0000

Thanks, Amy! That’s excellent news from the conference–It’s sobering (I couldn’t help it, with all the cocktail talk!) to hear about the challenges in the Netherlands, but I am hopeful that all of the energy building from consumers who are tired of being afraid and from researchers who are getting mainstream attention will continue gaining momentum and finally get ALL women the safe and satisfying pregnancies and births they deserve.

Comment on Do Cesareans Cause Endometriosis? Why Case Studies and Case Series are Canaries in the Mine by Denise Vokey

Denise Vokey — Thu, 29 Jul 2010 12:16:45 +0000

Well, it’s been a couple of months on the pill. Some side effects, but still pain. Having a laparoscopy in a couple of weeks.

Comment on Shake it up: Why we need research and activism to change maternity care by Henci Goer

Henci Goer — Wed, 28 Jul 2010 21:17:44 +0000

Amy Tuteur, MD :
Obstetricians are following the evidence? Really? Let’s just list a few routinely and commonly used obstetric management practices about which there is NO controversy in the obstetric research that they are ineffective, harmful, and generally both when used routinely or frequently and in some cases, with any use at all:

* induction for suspected big baby
* artificial rupture of membranes
* no oral intake other than ice chips
* I.V.
* continuous electronic fetal monitoring
* confinement to bed
* active management of labor (treating labor progress slower than average with high-dose oxytocin)
* directed pushing
* pushing on one’s back or in a semi-reclined position
* episiotomy (Episiotomy is on the decline, but it was still used in 1/4 of women having vaginal birth in 2005.)
* immediate umbilical cord clamping
* separating newborns from their mothers shortly after birth
* cesarean surgery (The research literature supports a rate of no more than 15%. At rates higher than this, maternal and perinatal morbidity and mortality rates begin to climb.)

I’m sure I’ll think of others after I submit this, and, of course, this list does not include anything from the much longer list of practices and policies about which there is controversy but a good case can be made against them for routine or frequent use.

Comment on Shake it up: Why we need research and activism to change maternity care by Erinmidwife

Erinmidwife — Tue, 27 Jul 2010 21:27:54 +0000

Thanks Amy Romano for spreading the news. We need to be aware of the global struggles in protecting normal birth, especially within societies that we glorify or exoticize for their dedication to physiologic, woman-centered birth.

“Evidence is not driving practice.”

Right. And I don’t even think ACOG’s latest flip-flop will have much of a trickle down effect, at least not any time soon. History has demonstrated that OBs do not generally budge from their comfort level. If ACOG wants to construct its authority over childbirth based on the “evidence” it generates, it needs to walk the talk.
What percentage of procedures, medications, and interventions in typical hospital births are truly evidence-based?

You are so right about that black hole between evidence and practice, and money and power seem to rise to the top. Only when we remove those elements from the equation will we see demonstrable birth change within the hospital system.

Comment on Shake it up: Why we need research and activism to change maternity care by Susan Jenkins

Susan Jenkins — Tue, 27 Jul 2010 20:17:06 +0000

Hi Amy (Romano, as opposed to A.T.),
[New thread here, since I don't want to play tag with Tuteur]:
Thanks so much for getting this info to Gene so he could talk about it and let me express much gratitude to Gene also. You are absolutely right — the internet and social media is the way people connect to each other and gain much of their information today — including women of childbearing age and the young women who will be the next generation of mothers. That’s why Amy T. lurks on the internet — so she can pop out every now and then to yell something that sounds scary to consumers.
So, as I understand it, if consumer demand is what it will take to change things, then our job is to educate consumers. And the way to educate consumers is through social media.
Look for an email from me in the next hour or so on some interesting ideas that I don’t necessarily want to share with Dr. T.

Comment on Shake it up: Why we need research and activism to change maternity care by Kathy

Kathy — Tue, 27 Jul 2010 19:34:54 +0000

Or it would be like going to med school and becoming an obstetrician and thinking you know everything you need to know about birth! See — I can do it too!

Comment on Shake it up: Why we need research and activism to change maternity care by Amy Tuteur, MD

Amy Tuteur, MD — Tue, 27 Jul 2010 17:47:33 +0000

“It seems to me that a “mainstream” conference would likely present only one side of the issue as well.”

I’ve been to quite a few conferences and I can assure you that is not the case. There are controversies in obstetrics just like there are controversies in any area of science. To understand what the evidence shows, you need to learn about ALL the evidence, not just the evidence you like. You can’t learn about the evidence for evolution by attending a creationism conference and you can’t learn about the evidence for modern obstetrics by attending a “normal” birth conference. You must also attend conferences that present points of view other than your own.

Comment on Shake it up: Why we need research and activism to change maternity care by Jill--Unnecesarean

Jill--Unnecesarean — Tue, 27 Jul 2010 17:11:37 +0000

Amy, that was officially the weirdest reply ever. I kind of enjoyed it’s uniqueness, though.

You: This conference has an ideological bias. Amy needs to go to conferences that do not have an ideological bias.

Me: Link to a conference about childbirth without an ideological bias.

You: ??? and no link to a conference without an ideological bias.

Me: *yawn*