Your OBGYN's Personal Beliefs Could Ruin Your Birth

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Not everyone who leans toward natural birth practices started there -- many have had bad experiences in hospitals or have been close to women who have. Sometimes it's women who read incredible amounts of literature on pregnancy long before peeing on the stick. It's not just patchouli-wearing, long-haired, barefoot hippies. It's law students, businesswomen, head of your PTA -- anyone. Especially with homebirth on the rise, it's safe to assume it's no longer just a fringe group of "weirdos."

Yet, many people still get accused of being conspiracy theorists, of thinking they "know better than doctors" and blown off like crazy freaks. Well guess what? It seems that many OBGYNs are letting their personal leanings interfere with their practice.

According to a new study, we aren't crazy when we point out that many common practices and recommendations aren't evidence-based -- less than a third of the American College of Obstetricians and Gynecologists recommendations are based on "gold-standard" scientific experiments.

According to Professor of Medicine, Dr. Andrew D. Auerbach, "more than two thirds" of recommendations are based on anecdotal evidence or even just expert opinions, which are wrought with personal biases. While opinion can be helpful where we don't know things, it doesn't always translate into what's best for the patients.

In the new study, Dr. Jason D. Wright of Columbia University in New York and colleagues went through 717 practice recommendations from ACOG, the nation's leading group of ob-gyns.

They found 30 percent of those were based on top-notch evidence, so-called randomized controlled trials. About 38 percent came from observational studies, whose value is limited, and 32 percent were purely expert opinion.

That's kind of scary to me, honestly. But it helps explain where quotes like these come from: "Twins are ready sooner because they grow faster than a singleton" and "In my experience, all Hispanic babies need formula."

I hate to say "I told you so," but seriously, when someone tells you that what your OB told you isn't sound, don't blow it off. When someone says, "Doctors don't know everything" or "I'd get a new doctor," most people aren't just trying to be self-righteous, arrogant assholes. Doctors CAN BE WRONG, and according to this study, they aren't using nearly as good of science as even I -- as a decently skeptical person -- believed they were. YOU are your best advocate. Do real research, ask around, ask people who disagree with you for sources of their claims, and find out yourself.

The study also noted that it's very important to go through literature and remove financial conflicts of interest from the office, and to make sure that panels for guideline review represent all stakeholders -- doctors and the patients alike. So yes, when we talk about offices having fingers in pies that hurt you as a patient, we're telling the truth.

When we have the Surgeon General, past and current, the Institute of Medicine, the World Health Organization, and the March of Dimes, to name a few, all saying that our hospitals and doctors are a huge part of the problem causing abysmal breastfeeding rates and premature birth and infant mortality, and then a study like this shows the good majority of our information isn't even based on good science ... well ... those home-birthers may not be sounding quite so crazy after all?

Are you surprised to find how little of the practices were using sound science?

 

Image via Daquella manera/Flickr

delivery, homebirth, labor & delivery, pregnancy health, tests & procedures, doctor visits, natural parenting

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SlapI... SlapItHigh

@Liz, I apologize for missing your name before.  You misunderstood again.  It's not whether there is data or not -- it's that it's a Practice Guideline.  We aren't talking about a doc who just offers an opinion where there is no data.  We are talking about official Practice Guidelines set forth by ACOG.  I hope you can understand the difference.

SlapI... SlapItHigh

You won't see a high percentage of practice guidelines in other fields of medicine that are based on purely opinion.  Much of these OB guidelines, there is no data b/c there is no need for data.  There are many unnecessary protocols that simply need to be abolished.  Why start a practice without any evidence to back it up?  That doesn't fly in any other field of medicine.  In OB, it's make a guideline first, look for evidence later or usually never.  B/c it's hard to change habit once a guidline is set in.  ABX for GBS is the perfect example of that.

AmyTu... AmyTuteurMD

SlapHigh,



Obviously, you haven't read the paper, either. Please read it BEFORE you presume to tell other people what it says.



The percentage of guidelines not based on gold standard evidence is actually HIGHER in other specialties. It gives specific figures for other specialties IN THE PAPER, which you would know if you read it.



You have also ignored the fact that ZERO percent of NCB and homebirth beliefs and guidelines is based on gold standard evidence like randomized controllled trials.

Momma... MommaGreenhalge

Anybody else totally not surprised that Dr. Amy showed up? I still don't understand why you are so against natural childbirth.  What do you have against women's bodies?


And maybe someone could provide a link to the study? 

Momma... Momma2blessed

It's funny how Dr Amy discredits NCB despite the fact that the practice has overwhelmingly better outcomes for mothers and babies. Last I remember statistical math is part of a science too.

miche... micheledo

It is fascinating to me, the more I become interested in midwifery and birthing at home, that the things I have read in midwife journals are NOW being recognized as good science! 


I don't know if scientific tests have been done for midwife practices - but science is beginning to back up the midwife's procedures on birth.  It's not the other way around.


AND, whether birthing in a hospital or birthing at home, YOU need to take control of what is going on.  Do your own research and trust your instinct.  It has actually been encouraging to read sites with the 'horror stories' of homebirth.  Over and over I see the moms saying they KNEW their baby was in serious trouble in spite of what the midwife said.  It just re-inforces to me that ultimately my health decisions (and the baby's) are in my hands.  NOT the midwife/OBgyn or whomever I have helping.

Stephanie Hayes

Oh, this rings so true. I am going for a VBAC with my second child. Policy where I deliver states I have to have a doctor. The midwife, who provided care for my first and was there through labor and my c-sect, is very supportive and all for it. The doctor, whom I saw once, and never met me before that doesn't "think" it's a good idea because "in his experience" blah blah blah. He doesn't even have the facts right from what went wrong the first time. Neither of our lives are in danger.. why do they always go for the knife. Plus, I know people who have almost died or lost limbs because their "doctor" said they were fine!

AmyTu... AmyTuteurMD

"NOW being recognized as good science"



No, that's not true and midwifery and homebirth advocates are well aware of it. That's why there is an ongoing effort in midwifery circles to discredit science itself. Consider midwifery papers like "Including the non-rational is sensible midwifery."



What do you think the emphasis on "intuition" and "other ways of knowing" is, if not an attack on scientific evidence? The reason that NCB and homebirth advocates are constantly invoking intuition is because scientific evidence does not support their beliefs.



Don't believe me? Find five practices exclusive to NCB or homebirth (in other words, not copied from obstetricians) and present the randomized controlled trials that support them.



NCB and homebirth advocates live in a giant echo chamber where they repeat misinformation to each other. Everyone else knows that the misinformation is untrue.

miche... micheledo

Maybe not science (though I highly doubt that), but in mainstream articles and news magazines, I have read that more and more doctors are recognizing the value of letting the cord continue to pulsate before cutting, of breech birth being safer then previously thought (NOT an immediate c-section) - those are the two I have recently read about.  And this is stuff coming from doctors - NOT midwife sites.  These are things I have read for a long time in midwife articles.

Momma... MommaGreenhalge

Information like what, Dr. Amy?  Because the only things I've had midwives and NCB advocates tell me is that medical interventions are really good ideas when medical emergencies arise, that my body belongs to me and therefore I have a right and respility to know what it is capable of and what needs to be done when something goes wrong, and that if I'm feeling a contraction then it really is a contraction.  The two OBs I've had the most experience with told me that my contractions weren't really doing anything, even though I was at 8cm, that my pubic arch was too narrow to birth a baby, even though I VBACed an eight pounder, and that I really needed to be induced, even though I really didn't. 


What misinformation are you referring to?  Is it the fact that women have the ability to know their own bodies better than doctors or midwives do?  That you can actually know to the day when you ovulate if you pay enough attention?  Or is it that we are perfectly capable of giving birth without intervention in most cases?

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