Any study of this nature is bound to be deeply flawed for the reasons you state Lynne. There would also be a lot of bias attached to this kind of a study because any centre willing to participate would already have a leaning towards intervention and caesarean section or they would find the whole idea unethical and would not participate as a result. For instance, if they underwent such a study here, a place like Salangor is unlikely to participate is it?
When I saw Brave New World in high school I thought it was disgusting that natural childbirth was such a foreign concept. But can you now see that happening in X years? I can and it scares me. Cheers, Cas. Cas McCullough [EMAIL PROTECTED] www.casmccullough.com -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynne Staff Sent: Monday, 20 October 2003 6:45 AM To: [EMAIL PROTECTED] Subject: Re: [ozmidwifery] C/S in Sydney Morning Herald We know the flaws in the touted breech trial were the location and quality > of staff chosen to assist in womens pursuence of vaginal breech. The > lack of > familiarity or experience itself was somewhat prohibitive. Not much is made > of this in the official critiques of this now perceived benchmark > study and > as a result women are misinformed and disempowered through a lack of > information. You have raised an interesting point here - let's just say the trial did go ahead and suppose women were randomised to either group. I wonder what the "standard" care would be for women randomised into the vaginal birth group? How and who would define what that would be? Would it be evidence-based? Woman-centred? Come from the exixting policies within each unit? Or is this proposed for one hospital only, rather than multicentre? And what information would be available to women about this?"If you are randomised to the caesarean group, then your care will include....If you are randomised into the vaginal birth group, then your care will include..... A caesarean is so controlled - and someone is 'doing the birth' - not the woman (sorry to all those out there who have chosen caesarean for whatever reason on this list, this is not meant to insult, but for the purpose of RCTs, randomisation and control of variables are of the essence, so to speak). How can one put such control on women who will labour in their own individual ways and who are the birthdoers? Are they all to have epidurals? Are they able to be up and about? How are the researchers going to work these little foibles out? ----- Original Message ----- From: "Selangor Maternity Centre" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Sunday, October 19, 2003 4:21 PM Subject: RE: [ozmidwifery] C/S in Sydney Morning Herald > Hi All, > > Thanks Lynne whereas I agree with the main theme of the > inappropriateness of > such a trial it is the randomisation that appears to be the major > sticking point. > > I would welcome a comparative trial as it would show, in my opinion without > a shadow of a doubt the benefits of vaginal birth over an over > employed obstetric intervention. > > The trial would instantly be flawed but I fear like the breech trial > would become a singular point of reference to all wishing to simply > advise women rather than empower women through information. > > We know the flaws in the touted breech trial were the location and > quality of staff chosen to assist in womens pursuence of vaginal > breech. The lack of > familiarity or experience itself was somewhat prohibitive. Not much is made > of this in the official critiques of this now perceived benchmark > study and > as a result women are misinformed and disempowered through a lack of > information. > > In the case for elective caesareans this would be the same, a unit > where the > randomisation of women to that extent could occur is not very likely > to be an actively birthing women centered unit? Now if we can only > remove the messy hit or miss act of conception by a controlled > trial....but then there is sometimes a lack of experience in this > department too for many...LOL > > > Love and Peace > Nigel > > > > > -----Original Message----- > From: Lynne Staff [mailto:[EMAIL PROTECTED] > Sent: Sunday, 19 October 2003 09:45 > To: [EMAIL PROTECTED] > Subject: Re: [ozmidwifery] C/S in Sydney Morning Herald > > > "there is this trial which gives you a 50-50 chance of totally > avoiding all > this pain........" > A father-to-be I saw the other day, whose wife has had 2 caesareans > (and is > having the devil of a time finding anyone to support her for a planned > vaginal birth), made the very pertinent point that 'natural' (read vaginal) > birth is ALWAYS portrayed as the worst pain a woman can ever have - > too terrible to contemplate, unbearable and totally avoidable, while > the portrayal of caesarean birth is ALWAYS pain-free, peaceful, smiles > all round.....etc > > Should publish some photos/stories of infected wounds, blood loss, how women > vomit when their uterus is pulled outside their abdominal cavity, > because it > is easier to suture, the trouble they have accessing their babies > because of > the physical limitation of spinals and post-op pain (although that is > becoming such an art that it is very 'manageable' nowadays), babies > with lacerations on their face or buttocks, babies on oxygen, > sometimes for a week, and the separation that goes with that....as you > can see this is a sore point with me. > > This trial disturbs me greatly for many reasons - but it's not just > the trial (although if the findings are that women like it better, > that it is as > safe), then God help us! The wholehearted embracing of the findings of > the term breech trial (which scares the living daylights out of me) > will pale into significance compared to this (and the findings from > the term breech trial will be no doubt used to substantiate the > rationale of this trial in the first place........) > > As I see it, one of the biggest probblems is the way information is provided > to the women in any 'obstetric' situation. I can imagine the way the > information will be provided for this. Major heebeejeebies. > ----- Original Message ----- > From: "Neretlis, Bethany" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Saturday, October 18, 2003 6:38 PM > Subject: RE: [ozmidwifery] C/S in Sydney Morning Herald > > > > we have been discussing this article too, or an offshoot from perth. > > it > seems to me to be a further automatic kneejerk reaction to litigation > from those experts at strange who are from the usa. i can just see > some insurance > company paying for this research, and unfortunately i can even see > some women being manovoured into it. can't you see some ob. finding a > scared pregnant woman who is vasilating over whether she wants to > suffer pain in labour and saying "there is this trial which gives you > a 50-50 chance of totally avoiding all this pain........" it just > makes you cry. i have run into this attitude towards vaginal birth > amoung surgeons and anaethatists when i worked in theatre so its not > too far a stretch of the imagination to > see where this came from. just the idea of someone being serious aout > this research gives me the heeijeebies. it would be sooooo immoral to > do this to > women. i'm sure that the researchers could somehow write it to pass an > ethics board, how i don't know, but they'd get some ethics lawyer > involved and before you know it , white isn't white at all, its black. > > > > love Bethany > > > > -----Original Message----- > > From: Justine Caines [mailto:[EMAIL PROTECTED] > > Sent: Friday, 17 October 2003 16:00 > > To: OzMid List > > Subject: [ozmidwifery] C/S in Sydney Morning Herald > > > > > > Hi All > > > > The SMH have confirmed the following letter will appear in > > tomorrow's > paper. > > > > Justine > > > > > > As soon as safety is mentioned in obstetrics by Obstetricians > > there's a > mad rush. > > > > What they neglect to inform us is that many of their practices are > > not > based on evidence and that despite huge medical intervention, safety > has not > improved in Australia. In fact the latest data on maternal deaths saw > an increase. This study represents a very sad fringe of the medical > profession. > > > > A woman is 4-5 times more likely to die from a caesarean section > > than from > a normal vaginal birth. A figure quoted in the last Senate Committee report > into childbirth procedures. It is also well noted that surgical > intervention in birth increases post-natal depression. With a C/S > rate 2.5 > times higher than the World Health Organisation recommends, high incidences > of post-natal depression and no report into what seems to be a high > incidence of maternal morbidity, this study would be highly unethical > and a > denial of a woman's most basic human right. > > -- > > This mailing list is sponsored by ACE Graphics. > > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > > > ********************************************************************** > This email and any files transmitted with it are confidential and > intended solely for the use of the individual or entity to whom they > are addressed. If you have received this email in error please notify > the system manager. > > This footnote also confirms that this email message has been swept by > MIMEsweeper for the presence of computer viruses. > > www.mimesweeper.com > ********************************************************************** > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
