Makes me shudder to read this stuff. I love how it's always OUR fault we get carved up because:
As the obstetric population becomes older, heavier,

and increasingly primiparous, the cesarean rate in the US

will continue to rise.

 

 

J

 

 

----- Original Message -----
Sent: Thursday, October 12, 2006 7:29 PM
Subject: [ozmidwifery] WV Based med rejected

This is part of the text of the last article.  Isn’t it amazing that individualization is O.K for obstetricians, but not for women wanting normal births? MM

 

The recent emphasis on evidence-based medicine has

tended to overshadow the need for individualization in

obstetrics. RCTs provide information about populations,

but cannot replace clinical judgment. Even if it is

true, for example, that cesarean section is generally safer

for babies in breech presentation, neither mother nor

child would be well served by emergency surgery performed

when the breech is on the perineum. Although

RCTs provide the highest level of evidence, their external

validity is often limited by small sample size and the

recruitment biases inherent to the research process.

Furthermore, investigators are not a random sample

of providers. In the statistical spirit of our time, it is

probably fair to say that clinical judgment and technical

ability are normally distributed within the profession.

These attributes are not often equally developed in the

same individual, nor is there any evidence that academic

achievement correlates positively with clinical excellence.

In light of such confounding factors, it is prudent to

maintain a degree of skepticism about the conclusions

of any study.

The future of cesarean section

‘‘.we have all regretted that we have not done a

cesarean in certain cases, but I have yet to regret one

that I have done.’’23

Few obstetricians would disagree with this sentiment,

expressed by a prominent New York obstetrician in 1920.

Given this attitude, is there an upper limit to the cesarean

rate? As the obstetric population becomes older, heavier,

and increasingly primiparous, the cesarean rate in the US

will continue to rise. This trend will be accentuated by

the reluctance, or inability, of obstetricians to perform

934 Cyr

 

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