Do Fundie Women Believe In Inducing Labor?

[Cran]

Whoa, mags, although that posting wasn't addressed to me, don't you think your tone is a bit... confrontational?

It is true that the term "infant mortality" is misapplied and misleading in this context. Before making such broad statements about the poster and her knowledge, perhaps you could have asked if she meant, instead of infant mortality, neonatal or perinatal mortality, depending on definition?

While the death in utero and after birth can have many cases, like an illness incompatible with life, the number of neonatal deaths is, if compared to other countries with similar economic means and similar culture, not the worst indicator for the quality of the care women and children receive under birth, although it is certainly also quite interesting for the quality of paediatric care: If two similar countries with different medical approaches have very different outcomes concerning neonatal deaths, one system seems to be more beneficial than the other.

Unfortunately, the data available isn't that new and not that reliable, but to be honest, if you compare North America (US and Canada) to Europe, excluding Eastern Europe, which in its economic setting and quality of medical care isn't fit for comparison, the numbers don't look that good for North America. It is certainly no waterproof proof (see what I did there?) that the US medical system is bad or ineffective, or that Obstetrics care in the US is bad, but it is a sign some things might be amiss or could be improved.

http://whqlibdoc.who.int/publications/2 ... 06_eng.pdf

No matter what rate of c-sections the poster you referred to, you or I think appropriate, the WHO thinks the rate should not exceed 15%.

http://www.cesareanrates.com/blog/2013/ ... ommen.html

[Mama Mia]

When I see this statement in the context of a debate on birth practices, I know that I can conclude the person making the statement is ill-informed at best and disregard any other statement made from said person. This is a popular lament in the natural birth community and among lay midwives and on the surface it SEEMS like a good argument because it is true. BUT, infant mortality has nothing to do with birth practices. It is the wrong statistic to use. You've clearly fallen into the trap of Google University by believing everything you read.

Now a homework assignment. Do some more research and find out the definition of infant mortality and what it means as far as medical care. To what medical specialty does it apply? Then find out the name of the statistic that applies to obstetric care and do a little reading about it. I could tell you the answers but you won't believe me (nor should you because I'm just someone on the internet) and it's probably a good exercise for you and anyone else who feels smug when using the infant mortality statistic inappropriately.

(While you're at it, I would be interested to know what c-section rate you think is appropriate. No need to provide evidence to back up your opinion because no such evidence exists. No one else knows what the appropriate rate is but you apparently want to judge the hell out of a rate that YOU seem to think is too high.)

Oh please, please, please your highness, do give your explanation for the abominably high infant mortality rates in the U.S. I just can't WAIT to hear them! Let me guess........I bet it will have something to do with 1) poor/ young/ minority mothers having higher rates, which you will then pawn off on their lack of education/ poor eating habits/ general ignorance/ lack of medical care ( while pretending you're not racist/ageist/elitist ) while completely ignoring that it's the medical care that they do receive that is often the cause of their problems and 2) blame it on the extremely premature infants being counted in infant mortality rates while completely ignoring that there are other countries with much lower rates of death for even extremely premature infants.

Is that about right? :roll:

And your snarky comment about the c-section rate is profoundly idiotic. Throughout history, before easy access to c-sections, did a third of birth result in either death or disability? No? Than why on earth would a third of births require a c- section now? :angry-banghead:

I have nothing against needed interventions. My rage at my daughters doctor is actually over not performing a c-section sooner, when a 5 year old could of seen it was necessary.

Many doctors are great. Many lives are saved and improved every day by great doctors.

It is the special snowflake combination of arrogance and ignorance displayed by many Doctors that is infuriating and dangerous.

[NotALoserLikeYou]

(While you're at it, I would be interested to know what c-section rate you think is appropriate. No need to provide evidence to back up your opinion because no such evidence exists. No one else knows what the appropriate rate is but you apparently want to judge the hell out of a rate that YOU seem to think is too high.)

Well, the World Health Organization recommends that the csection rate should be no higher than 10-15% so let's go with that.

http://www.who.int/bulletin/volumes/85/10/06-039289/en/

If the csection rate was 5% in the U.S. in 1970 (http://www.cdc.gov/mmwr/preview/mmwrhtm ... 001044.htm), I don't think that suddenly another 28% of the population lost the ability to birth over the last few decades. Maybe some increase is normal, with older mothers and multiple births, but that is not the norm.

[Coconut Flan]

What happened between 1970 and 1986 to cause the rate to go up so much? Insurance rates? Lawsuit changes? Medical guidelines?

[Escapefromfundiedom]

One thing I find baffling on this forum is that despite the opposition to patriarchal systems within religious groups, there seems to be a great affinity towards patriarchal systems in healthcare. There should only ever be one person in charge of making decisions regarding regarding pregnancy and birth, and of course that is the woman herself. The idea that because a woman has reached 42 weeks gestation, that her doctor should step in and schedule an induction is rather ridiculous and not at all taking into consideration the individual needs or overall health of the mother and baby.

However I do acknowledge, that some women in these families will be taking direction from their headship, in regards to whether they have seen or will see a care provider during pregnancy. This is just as abhorrent as an Obstetrician believing he has decision making rights for the woman.

Inductions for healthy women and babies come with risk as does waiting for labour to begin in it's own time. The decision to do either should always be with the woman.

midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/

:clap: :clap: :clap: :clap: :clap:

You are my new favorite person on FJ!

[mags]

Whoa, mags, although that posting wasn't addressed to me, don't you think your tone is a bit... confrontational?

It is true that the term "infant mortality" is misapplied and misleading in this context. Before making such broad statements about the poster and her knowledge, perhaps you could have asked if she meant, instead of infant mortality, neonatal or perinatal mortality, depending on definition?

While the death in utero and after birth can have many cases, like an illness incompatible with life, the number of neonatal deaths is, if compared to other countries with similar economic means and similar culture, not the worst indicator for the quality of the care women and children receive under birth, although it is certainly also quite interesting for the quality of paediatric care: If two similar countries with different medical approaches have very different outcomes concerning neonatal deaths, one system seems to be more beneficial than the other.

Unfortunately, the data available isn't that new and not that reliable, but to be honest, if you compare North America (US and Canada) to Europe, excluding Eastern Europe, which in its economic setting and quality of medical care isn't fit for comparison, the numbers don't look that good for North America. It is certainly no waterproof proof (see what I did there?) that the US medical system is bad or ineffective, or that Obstetrics care in the US is bad, but it is a sign some things might be amiss or could be improved.

http://whqlibdoc.who.int/publications/2 ... 06_eng.pdf

No matter what rate of c-sections the poster you referred to, you or I think appropriate, the WHO thinks the rate should not exceed 15%.

http://www.cesareanrates.com/blog/2013/ ... ommen.html

Yes, I'll admit to confrontational. I've been in these debates before and being nice gets ignored on the internet. Don't worry though -- I'm nice in real life.

I believe that women have the right to choose what they want to do regarding birth. I also believe that women should be given accurate and appropriate statistics for their circumstances to make truly informed decisions regarding birth. The infant mortality statistic is accurate but it doesn't have much to do with obstetric care. (For those who don't feel the need to look it up, infant mortality is death less than 1 year of age and is a better indicator of pediatric care rather than obstetric care.) It's not appropriate to use infant mortality statistics to make decisions on birth practices. If someone is misusing stats to support a statement then I think it's fair to ask the person to re-evaluate their level of knowledge about the subject. The internet may indeed be the great equalizer but it has also uncovered a serious lack of critical thinking skills. If you are using infant mortality rates as a reason to change the birth practices in this country then you clearly don't have a good grasp on the subject. If you are saying "infant mortality" when you really mean "perinatal mortality" well...don't do that. It's confusing and it makes people think that you don't know what you're talking about.

Regarding the c-section rates...The WHO retracted their statement a few years ago because there is no evidence to support it. From the article you linked:

The bulk of the text on the 15% threshold is found on page 25 of the handbook.

Minimum and maximum acceptable levels

Both very low and very high rates of caesarean section can be dangerous, but the optimum rate is unknown. Pending further research, users of this handbook might want to continue to use a range of 5–15% or set their own standards.

Background

The proportion of births by caesarean section was chosen as the indicator of provision of life-saving services for both mothers and newborns, although other surgical interventions (such as hysterectomy for a ruptured uterus or laparotomy for an ectopic pregnancy) can also save maternal lives. Of all the procedures used to treat major obstetric complications, caesarean section is one of the commonest, and reporting is relatively reliable (124).

Earlier editions of this handbook set a minimum (5%) and a maximum (15%) acceptable level for caesarean section. Although WHO has recommended since 1985 that the rate not exceed 10–15% (125), there is no empirical evidence for an optimum percentage or range of percentages, despite a growing body of research that shows a negative effect of high rates (126-128). It should be noted that the proposed upper limit of 15% is not a target to be achieved but rather a threshold not to be exceeded. Nevertheless, the rates in most developed countries and in many urban areas of lesser-developed countries are above that threshold. Ultimately, what matters most is that all women who need caesarean sections actually receive them.

So, it seems that you can set your own standards. There will never be an ideal c-section rate. If even one woman doesn't get the c-section that saves her baby's life because a doctor doesn't want to go over someone's opinion on the ideal percentage then a great disservice has been done. Yes, there are unnecessary c-sections but that can only be evaluated in hindsight.

[Cran]

Ah. That's truly evidence-based if everybody gets to set his own standards. And how is the average OB (or you) equipped to make a good decision about the appropriate rate?

If you read the quote you took from the site carefully, you'll also see that there is growing evidence that high c-section-rates are not beneficial, so there's hardly evidence for aiming for a percentage that exceeds the not-to-be-taken-as-asbolute recommendation of 15%. The recommendation is still not to exceed this 15%, and the US are above 30. This really can't be brought into accord with what the WHO said, as you try to make it sound by using the word "retracted".

And I do not agree with the statement that unnecessary c-sections can be recognized as such in hindsight. If the baby is healthy, nobody will be able to tell if it would have been healthy without a section or if it wouldn't have been.

And btw, I'm no nice person in real life (or on the internet), and so I say what I think about you, mags: The way you reacted here, even if it is a discussion you're sick of, is an indication of your character. You were condescending and smug. I do not believe we're different on the internet, I believe we show how we truly are on the inside. And that's why I pity your patients.

[Coconut Flan]

Is mags the med student?

[mags]

Oh please, please, please your highness, do give your explanation for the abominably high infant mortality rates in the U.S. I just can't WAIT to hear them! Let me guess........I bet it will have something to do with 1) poor/ young/ minority mothers having higher rates, which you will then pawn off on their lack of education/ poor eating habits/ general ignorance/ lack of medical care ( while pretending you're not racist/ageist/elitist ) while completely ignoring that it's the medical care that they do receive that is often the cause of their problems and 2) blame it on the extremely premature infants being counted in infant mortality rates while completely ignoring that there are other countries with much lower rates of death for even extremely premature infants.

Is that about right? :roll:

And your snarky comment about the c-section rate is profoundly idiotic. Throughout history, before easy access to c-sections, did a third of birth result in either death or disability? No? Than why on earth would a third of births require a c- section now? :angry-banghead:

I have nothing against needed interventions. My rage at my daughters doctor is actually over not performing a c-section sooner, when a 5 year old could of seen it was necessary.

Many doctors are great. Many lives are saved and improved every day by great doctors.

It is the special snowflake combination of arrogance and ignorance displayed by many Doctors that is infuriating and dangerous.

So, I guess you don't feel like looking up infant mortality vs. perinatal mortality and what those stats mean. As far as infant mortality, I actually DO think that lack of access to medical care may contribute to the increased infant mortality. The groups that tend to not have great access are the same groups that have the highest infant mortality in the US. Please tell me how this makes me racist/ageist/elitist? (Nice. I love a good ad hominem attack instead of relying on facts.) The US perinatal mortality rate is on par with other developed countries.

[Arete]

No, she is not the med student from the Jahi thread.

[Coconut Flan]

OK, thanks.

[mags]

Ah. That's truly evidence-based if everybody gets to set his own standards. And how is the average OB (or you) equipped to make a good decision about the appropriate rate?

If you read the quote you took from the site carefully, you'll also see that there is growing evidence that high c-section-rates are not beneficial, so there's hardly evidence for aiming for a percentage that exceeds the not-to-be-taken-as-asbolute recommendation of 15%. The recommendation is still not to exceed this 15%, and the US are above 30. This really can't be brought into accord with what the WHO said, as you try to make it sound by using the word "retracted".

And I do not agree with the statement that unnecessary c-sections can be recognized as such in hindsight. If the baby is healthy, nobody will be able to tell if it would have been healthy without a section or if it wouldn't have been.

And btw, I'm no nice person in real life (or on the internet), and so I say what I think about you, mags: The way you reacted here, even if it is a discussion you're sick of, is an indication of your character. You were condescending and smug. I do not believe we're different on the internet, I believe we show how we truly are on the inside. And that's why I pity your patients.

I'm not equipped to make a good decision about the appropriate c-section rate. No one is. That's my whole point. People's opinion of what the appropriate rate is has no place in a debate on birth practices. Well, not a debate based on evidence. (Even the WHO admits that it is an opinion and there is no evidence to support it...but yeah, 15% sounds good...or whatever you want to set as your own standard. I didn't make up the line about setting your own standards -- it's in the article!)

I actually agree with the second bolded statement but it sure seems that people like to judge whether a c-section was necessary or not. I was trying to make the point that the OB doesn't even have the (variable) benefit of hindsight when making the decision to recommend a c-section.

I can take the criticism of my character. I think I have very good character considering that I feel strongly that women should be give accurate and appropriate information to make the best decisions regarding birth.

[mags]

Well, the World Health Organization recommends that the csection rate should be no higher than 10-15% so let's go with that.

http://www.who.int/bulletin/volumes/85/10/06-039289/en/

If the csection rate was 5% in the U.S. in 1970 (http://www.cdc.gov/mmwr/preview/mmwrhtm ... 001044.htm), I don't think that suddenly another 28% of the population lost the ability to birth over the last few decades. Maybe some increase is normal, with older mothers and multiple births, but that is not the norm.

Your link to WHO is from 2007. They retracted the statement a few years later because of lack of evidence to back up their statement/opinion.

I think you are misunderstanding the reason for most c-sections. The reason to do a c-section is usually to get the baby out safely. Traditionally and throughout history, the baby does come out. It may be at the expense of its life or the life of the mother or it may cause significant morbidity in the mother and/or child, but the baby does get out. I'm more interested in the comparison of perinatal or neonatal mortality in 1970 vs the present to really compare the implications of higher vs lower c-section rates.

[singsingsing]

I've never seen people more entrenched in their positions, nasty and accusatory, than when debating childbirth on the internet. It's a shame because the internet can be a great resource for information and a feeling of community, but if I ever get pregnant I know that I will NEVER discuss anything about it online.

[ljohnson2006]

Sorry that I opened this can of worms.

[Mama Mia]

So, I guess you don't feel like looking up infant mortality vs. perinatal mortality and what those stats mean. As far as infant mortality, I actually DO think that lack of access to medical care may contribute to the increased infant mortality. The groups that tend to not have great access are the same groups that have the highest infant mortality in the US. Please tell me how this makes me racist/ageist/elitist? (Nice. I love a good ad hominem attack instead of relying on facts.) The US perinatal mortality rate is on par with other developed countries.

As I'm sure you are perfectly aware, it is impossible to accurately compare statistics on perinatal mortality across countries as different countries have different definitions of what counts in the perinatal period. If one country includes all infants born at 22 weeks and another only includes those born at 28 plus weeks you are going to get vastly different results. So please, do tell how could a 30% + c-section rate be considered desirable?

How about looking at the mortality of the Mothers? Would that fit your criteria? There are 46 countries that do a better job at keeping mothers alive.

And I don't think it is just lack of access to care that endangers poor, young and minority women disproportionately, it's lack of GOOD care, which is not the same thing.

[Adrienne83]

No one is against necessary Csections. What is offensive is the idea that over a third of women can't give birth. It's false and harmful as a csection is serious surgery with more risks and possible complications than a vaginal birth, for both mother and baby.

I had a homebirth for my second and was planning on one for the third. Had complications and was glad to go to a hospital. I'm not against hospitals or necessary surgery. I'm against the way many women are treated during pregnancy and birth in this culture where almost all births are medicalized and managed and subjected to numerous interventions.

I'm sorry that my inability to give birth offends you. Even though you say that no one is against necessary C-sections, you sure sound pissed at the number of C-sections. They all can't be unnecessary. :roll:

Believe me, I know how serious a C-section is. Unless you had one, you have no idea what it feels like. I can only speak for my case, and it wasn't a willy nilly decision.

I'm honestly glad you were able to have a home birth with your second and everything turned out ok with your third.

[Adrienne83]

I don't know you, but I'm glad you had a medical intervention available to you that saved both your life and that of your son.

I am not a mother, just an aunt. But what I've observed of random strangers' interactions with my sister-in-law suggests that if you are a woman and are parenting, people whose opinions you never asked are going to tell you that You're Doing It Wrong, no matter what you're doing.

That kind of shaming is a messed-up and gross byproduct of a society that believes women's bodies are property and, thus, other people's business. And seeing it happen up close has had a moderating effect on my snark instinct.

Lol, you sure got that right! I have so many stranger stories. Soooooooooo many. I hope your sister in law has a snappy come back for all the know it all's. :)

[Adrienne83]

A necessary c-section is a wonderful thing. But an unnecessary one isn't.

Or would you be glad if you went to the dentist, he told you you had a very little cavity and pulled your tooth, and the ones next to it, too "just in case"?

A c-section is a major abdominal surgery, with all the risks that come with surgery, and carries risks for future pregnancies and the natural birth process is also beneficial for the child (preparation of lungs, contact with beneficial bacteria in the vagina). Such an operation shouldn't be undertaken lightly or for no good reason.

And we know that the rate of c-section many industrialized nations have (well over 30%) is too high and not medically necessary. And also not caused by elective c-sections, which are, in the complete picture, quite rare. They are caused by a false assessment of the risk mother and child are in during the last stages of pregnancy or during birth.

For example: "Large baby" (which turns out to be perfectly normal - ultrasound in late stages of pregnancy does not predict birth weight accurately), a previous c-section ("Just to be sure, we want no uterine rupture!" - the risk is elated, but not as high as to make a vaginal delivery very risky) or a breech baby/twins (which can be delivered vaginally in most cases, most providers just have no experience with it, are afraid and prefer the cut).

Over-treatment is malpractice as well as refusing necessary treatment.

I don't know if you are comparing my c-section to getting a tooth pulled, or to C-sections in general. Believe me, I know a c-section is a major surgery. I had one! And believe me, I didn't want it. Considering how I wanted my son and I to both live, it seemed like a fair trade off. My son was a breech baby with other complications that I don't really feel comfortable going into on here. It's not always so cut and dry to say just turn him. If I had a dollar for how many times people have said that to me, I'd be a millionaire. :angry-banghead:

[mags]

As I'm sure you are perfectly aware, it is impossible to accurately compare statistics on perinatal mortality across countries as different countries have different definitions of what counts in the perinatal period. If one country includes all infants born at 22 weeks and another only includes those born at 28 plus weeks you are going to get vastly different results. So please, do tell how could a 30% + c-section rate be considered desirable?

How about looking at the mortality of the Mothers? Would that fit your criteria? There are 46 countries that do a better job at keeping mothers alive.

And I don't think it is just lack of access to care that endangers poor, young and minority women disproportionately, it's lack of GOOD care, which is not the same thing.

Yes, I know that perinatal mortality definitions vary across countries so comparison to the US is not always easy. In general, the US is on par with other developed nations. I'm not sure how that ties in to the desirable c-section rate. I don't know what c-section rate is desirable. No one does. I'm not sure how many times I need to write that. My point is that women should not be basing birth decisions on someone else's opinion that the c-section rate is too high when there is no evidence on the matter.

Maternal mortality is another indicator of obstetric care so it would certainly fit my criteria for an appropriate statistic to use when making decisions regarding obstetric care. I've never said that the US is the greatest when it comes to obstetric care (because it isn't) and there are definitely changes that could be made to improve care. I'm only advocating that women use accurate and appropriate statistics when making birth decisions. The popular use of infant mortality is not appropriate.

[mags]

Sorry that I opened this can of worms.

I feel like I need to apologize for participating in the derailment. I actually opened the thread because it is an interesting question to discuss. I'm sure there is a continuum among fundie women based on their personal preferences just as there is among non-fundie women but I imagine that most would agree to induce if their provider felt it was necessary. Even Zsu, the hard core home birth with a midwife advocate, has done whatever her providers deem necessary during this pregnancy.

I believe Kelly at Generation Cedar has had all of her babies in a hospital and had an epidural with all except one. Afterward she wrote that she would be opting for the epidural again for any future births. It seemed like she just wanted to try a non-medicated birth and didn't like it so much.

[YPestis]

I disagree. In my experience many people are able to find out what is wrong with them and get appropriate treatment ONLY because of Dr.Google, websites and forums. Because their own G.P. will have no idea what is wrong and write off anything unexplained as being " stress" or psychosomatic or just let it drop. It is only through researching the symptoms themselves and finding hundreds or thousands of people going through the same thing that they might have an idea of what could be wrong, and often that idea will turn out to be correct and they can start to get help. Obviously this can be carried too far,and some people will freak out about every little sniffle, but there are a shocking number of people suffering from various diseases who were brushed off for years by the medical providers. I know this is often true with autoimmune diseases.

Also even without attending medical school most reasonably intelligent people can learn how to slog through medical terminology and read professional articles. What is unfortunate is that many Doctors seem too invested in their pride to hear new information if it doesn't come from another Doctor.

....

Or, in my daughters case, if a 9 month pregnant patient presents saying that 1) She thinks she is leaking amniotic fluid 2) she has a fever of 104 3) her abdomen is painful and hot and 4) when she's in the hospital and her water fully breaks it is filled with meconium .........Maybe, possibly, the f&$$) Dr. should listen when she says there is a problem and should of known, without being told by the patient, that she had chorionamniotic infection.

In ways I think the Internet is a huge equalizer not just for political movements but for a wide range of issues, including health problems.

Sorry, I had to cut your reply but I wanted to focus on the bolded aspects first.

In the first bolded part, I mentioned that there's a certain amount of professional judgement that comes into play when reading a medical article. Reasonably intelligent people can read a medical paper but may lack the training to discern and interpret, especially within context of their medical history. Rather than believing the doctor arrogant for disagreeing with said document, it could also be professional disagreement.

There are patients that come in clutching the latest treatment studies from JAMA. Then there are patients come in with the latest from Jenny McCarthy (what's HER body count?). I've heard of plenty of physicians (including my husband) who have accepted and changed their view based on their patients' findings. However, that's because the patient is coming in with a resource that the doctors' themselves use. Non-medical websites and anonymous forums are suspect because they are filled with anecdotes and unverifiable stories. Not all information is created equal. Some patients know this different, but some don't.

I feel more dangerous than someone who is ignorant is someone who has a little bit of knowledge....just enough to feel confident that they know what's going on, but not knowledgeable enough to understand the complex picture. I think it's good to come in informed about one's prognosis. But just as docs can be arrogant, so can patients.

In these debates about arrogant doctors versus ignorant patients, I don't side with one or the other. I believe patients should dump docs they don't feel confident with, just as doctors should try to work with patients with whom they disagree with medically.

As for the second bolded part, that was the fault of the physician. The fact that this happens is horrible, but it no ways means that physicians, as a group, are technically incompetent. One of the first things we learned in clinicals was that a physicians' most important tool for diagnosis is the patient herself. Not everyone remembers that, it seems, but I don't think the profession, as a whole, acts like this.

I generally agree that the internet is a great equalizer but I think it also add to the confusion. Information is empowering but it can also be misleading. Just because someone browses the internet for information, doesn't make them "informed". Given the sad state of science education in this country, I think many Americans don't know how to discern between real science and junk science. Heck, it's 2013, and half the country thinks evolution is an atheist conspiracy.

Just as patients struggle to be heard amongst the arrogant physicians, many physicians struggle to be heard amongst the white noise that goes for "medical information" floating around the internet.

[NotALoserLikeYou]

I'm sorry that my inability to give birth offends you. Even though you say that no one is against necessary C-sections, you sure sound pissed at the number of C-sections. They all can't be unnecessary. :roll:

Believe me, I know how serious a C-section is. Unless you had one, you have no idea what it feels like. I can only speak for my case, and it wasn't a willy nilly decision.

I'm honestly glad you were able to have a home birth with your second and everything turned out ok with your third.

No, they are not all unnecessary, hence why I said no one is against necessary csections. They exist and thank goodness for that. I am also not offended by your inability to give birth. Did I remotely say anything like that? I am offended by doctors giving a third of women major surgery that carries increased risks for mother and baby [compared to vaginal birth] when a lot of them don't really need it, or would not have needed it if the physician had not induced/broke the water/otherwise intervened in the first place. It's about women getting appropriate care and being fully informed and having a say in their birth. I don't really care how a particular woman gives birth but I do care how a doctor views birth, and how a hospital treats birth. Especially since so many women put their full trust in them. They should deserve that trust.

[YPestis]

We wish we'd practice evidence-based medicine! This is a goal that hasn't yet been achieved because many procedures established now are not thoroughly tested or can't be tested because it wouldn't be ethical to do so (for example, not operating upon people with appendicitis to see how many would actually die - this study is not going to happen). And even IF there is evidence, this does not mean it will be followed by the practitioners. OBs, for example, do often considerably stray from the guidelines laid out by ACOG.

A doctor will not

a) necessarily practice evidence-based medicine.

b) necessarily pay attention to the data produced by medical scientists.

c) have the time to study all available studies for every case he has to treat, while a person actually affected by a condition might very well do this.

d) be magically immune from malpractice because he or she is a doctor.

And being no doctor doesn't ban anyone from accessing data evidence-based medicine should be based on.

I'm not disputing that there is a problem with the practice of EBM. Yes, not all medical practices are based on the gold standard with double blinded studies, but we we can still do retrospective studies even if experimental ones are not allowed. And yes, doctors do ignore ACOG guidelines and that is sometimes unfortunate. However, I dispute the idea that patients are all looking through the proper studies themselves. Just as physicians vary in their quality, so do patients in their knowledge. In my experience, plenty of patients come in with information from questionable sites. Not everyone is checking out pubmed and NEJM. From all the docs I know, the ones with patients that do stay well informed are typically thought highly of by their doctors. I guess I am more fortunate than many others....

I'm not sure what you meant about the malpractice bit....OBs have the third highest malpractice of all medical specialties. In fact, the high c-section rate is due, in part, to the the fear of litigation.....

The problem I have is hearing people say that OBs are wrong on some standard protocol due to some paper they pull out, without realizing that perhaps there's a mountain of data that disputes said paper. It's like the autism-vaccine link. Jenny McCarthy keeps touting the initial (now discredited) paper which initially produced the link, yet ignores the MOUNTAINS of data since then that disputes such a link. Science is an ongoing progress. Not all patients are equally good at keeping up with the latest studies. Furthermore, papers can be subject to misinterpretation due to a lack of a science background. Patients can be just as guilty of hubris as doctors.

Ideally, I would like to see patients stay informed with the latest information but from reputable sources. I would like to see more doctors tailor their treatments. It's the cookie cutter way of practicing medicine that causes so much friction. As we've seen this thread, some doctors just ignore what their patients are telling them.

In the end, the final decision should always lie with the patient. The doctor may or may not know what's right, but only the patient should have the final say.

[Mama Mia]

[quote="YPestis"However, that's because the patient is coming in with a resource that the doctors' themselves use. Non-medical websites and anonymous forums are suspect because they are filled with anecdotes and unverifiable stories. Not all information is created equal. Some patients know this different, but some don't.

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