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 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 will
continue to rise. This trend will be accentuated by the
reluctance, or inability, of obstetricians to perform 934
Cyr |
- [ozmidwifery] WV Based med rejected Mary Murphy
- Re: [ozmidwifery] WV Based med rejected Janet Fraser