Why are some obstetricians suddenly all up in arms about traditional practices that help women take control of their births?
Surely anything that helps women and does no harm should be encouraged.
It doesn’t make sense that obstetricians would not want women to have easier more pleasurable births. Or does it?
Lately, some obstetricians have been calling these traditional, low intervention approaches to birth “quackery”, claiming they are non-evidence based.
I could go into the research behind some of these approaches but let’s look at a few routine obstetric practices that could be considered “quackery” if we are using the definition as non-evidence based.
Despite the evidence that not all women’s bodies function in exactly the same way (surely common sense tells us this too) obstetric models of care still want to intervene if a woman’s cervix isn’t dilating more than 1 cm/hr after 4 cm.
This model is based on a very outdated piece of ‘research’ that averaged a 100 women’s dilatation in the 1950s.
Despite the fact there is much newer evidence saying active labour is not until 6cm and a threshold of 1 cm/hour throughout labour is unrealistic and unhelpful for most women doctors continue to intervene in physiological labour simply because it is not progressing as fast as their textbooks tell them it should.
Even the World Health Organization have written guidelines telling us to stop intervening simply because of outdated beliefs about how long labour should be.
Timing of labour: Quackery or evidence based?
2. Continuous Electronic Fetal Monitoring (EFM)
EFM was introduced in the 1970s without evidence from clinical trials and was marketed as a scientific breakthrough that could end cerebral palsy.
The Cochrane Review has shown EFM has made no difference to cerebral palsy rates but does increase c/section rates.
Despite this many low-risk women are being continually monitored through their labours and obstetricians refuse to believe it is a factor in our ever-rising caesarean section rates.
EFM: Quackery or evidence based?
3. Artificial Rupture of Membranes. (ARM)
This is performed because the obstetric model believes it helps speed up labour (again, why are we speeding up labours that don’t actually need speeding up?).
However, the Cochrane Review keeps telling us it doesn’t.
“The review of studies assessed the use of amniotomy in all labours that started spontaneously. There were 15 studies identified, involving 5583 women, none of which assessed whether amniotomy increased women’s pain in labour. The evidence showed no shortening of the length of first stage of labour and a possible increase in caesarean section. Routine amniotomy is not recommended as part of standard labour management and care.”
ARM is still a very common intervention in physiological birth.
ARM: Quackery or evidence based?
4. Insisting women birth on their backs.
There is no good evidence to insist a woman births on her back. It is done purely for care givers convenience.
Giving birth on your back means you are more likely to have a forceps or vacuum-assisted birth, more likely to have an episiotomy, more likely to have abnormal fetal heart rate patterns, more likely to have a second-degree tear, more likely to have estimated blood loss greater.
Yet around 70% of Australia woman are still giving birth on their backs.
Insisting women birth on their backs: Quackery or evidence based?
I think you may be noticing that these non-evidence-based practises are not only not doing what doctors think they are doing but they are also increasing the risk to mums and babies.
What happened to first do no harm?
I could go on but it is depressing me too much.
I’d rather focus on some recent research into practices midwives have always done but obstetricians refused to because they didn’t have the “evidence” before now.
1.Delayed Cord clamping
In May this year, it was reported that “The Royal Women’s Hospital has launched Australia’s first study that aims to help newborn babies who do not breathe spontaneously after birth, by delaying the clamping of the umbilical cord”.
I actually thought the headline should be “Routine obstetric practice has been putting babies at risk for decades”.
There is already a lot of other evidence of the benefits of waiting for the cord to go white. #waitforwhite
But hopefully, this latest bit of research will mean doctors will finally stop clamping the cord until they have check babies are actually breathing. Something good midwifery practitioners have always done.
2. Immediate Skin to Skin
Dr. Gannon is one of the obstetricians who has called some traditional practises “quackery”.
He also said skin to skin was a ‘fad’ not long ago. I did respond to this in another blog.
Hopefully, he has put down his textbook and looked at this new research that showed skin to skin can help babies maintain their blood glucose levels.
There was similar research about this in 2017 with babies who needed to go to neonatal intensive care that concluded: “The SSC intervention was safe and feasible with no adverse events.”
Again midwives have always known that the traditional practise of placing a baby straight onto mum has enormous benefits but perhaps now we can call it an “intervention” obstetricians and paediatrician will start doing it.
3. Physiological births lower the risk of Postpartum Haemorrhage.
I am less optimistic about this research changing practise although it does give evidence to what so many midwives already knew.
The research did find that “women who had an unassisted vaginal birth had the lowest incidence of primary postpartum haemorrhage, while women who had a caesarean birth had the highest. Those who had forceps births had the highest incidence of severe postpartum haemorrhage”.
However the recommendation for the study was not to find out how midwives promoted physiological birth and therefore lower postpartum haemorrhages, it was to teach doctors how to “promptly detect and initiate treatment for excessive blood loss”.
Again, how about not causing the problem in the first place?
It is so frustrating that doctors dismiss traditional low intervention midwifery practise as quackery until they have the “evidence” to say it works yet they are quite comfortable introducing, high tech solutions to problems that modern obstetric practises have probably caused before they have been fully tested.
I don’t want to be cynical and say there are no incentives for obstetricians to encourage practices that might mean women don’t actually need obstetricians. But….
So before we start burning midwives as witches at the stakes again, perhaps obstetricians could stop and look at the evidence that midwives are the experts in physiological birth. And the evidence that most women actually don’t need medical intervention in a normal physiological process.
They could even attend some of the Australian College Of Midwives study days before completely writing them off.