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- Page navigation anchor for Time has come for an RCT of conventional obstetric management vs physiologic care NOT elective surgery vs planned vaginal deliveryTime has come for an RCT of conventional obstetric management vs physiologic care NOT elective surgery vs planned vaginal deliveryShow More
The concept of an RCT of elective cesarean surgery vs. “attempted vaginal delivery” fails to meet either ethical or scientific standards. Science dictates that RCTs are only called for when there is justification, that is, a body of observational evidence suggests that a treatment or practice might prove to be beneficial. No such body exists in this case. On the contrary, we have ample evidence that elective cesarean sur...
Competing Interests: None declared. - Page navigation anchor for Need for research prior to adopting obstetrical interventions:Patient request cesarean and vaginal breech deliveriesNeed for research prior to adopting obstetrical interventions:Patient request cesarean and vaginal breech deliveriesShow More
We agree that research is clearly needed to determine the relative maternal and neonatal morbidity of cesarean vs. vaginal delivery. The research efforts need careful design to ensure that the outcomes are applicable to diverse populations. Drs Lee and D’Alton, as well as the NIH consensus conference on maternal request cesarean delivery (1) , remind us of the need to use an intention to treat analysis when comparing...
Competing Interests: None declared. - Page navigation anchor for Cesarean Delivery: a choice, a demand, or a request?Cesarean Delivery: a choice, a demand, or a request?Show More
Cesarean Delivery: a choice, a demand, or a request?
Young Mi Lee, MD and Mary E. D’Alton, MD
There is no question that cesarean delivery on maternal request is the topic of much recent discussion and that debates are only expected to increase with time. In this issue, Leeman and Plante voice the concern that many healthcare providers fear: a rise in use of a surgical procedure before research yields an...
Competing Interests: None declared. - Page navigation anchor for Choices: Lack of improved outcome vs Super saver airline ticketsChoices: Lack of improved outcome vs Super saver airline ticketsShow More
Thank you to Drs. Leeman and Plante for this thoughtful Reflection.
The rapidly increasing cesarean rate has not improved commonly measured patient outcomes. In this same issue of the Annals of Family Medicine Zweifler et al on a large 1996 through 2002 California study of the Birth Statistical Master Files were used to identify 386,232 California residents who previously gave birth by cesarean delivery and ha...
Competing Interests: None declared. - Page navigation anchor for What a difference a day makes in "cesarean section on maternal request"What a difference a day makes in "cesarean section on maternal request"Show More
Yesterday, prompted by the thoughtful reflections of Leeman and Plante,(1) I responded to the issue of restriction of choice of mode of birth by assessing the impact of the recent NIH Conference on “Cesarean Section on Maternal Request.” I summarized some of the key recommendations and expressed concern about the implications for physiologic birth practice. Today the final summary and recommendations of that Conference...
Competing Interests: None declared. - Page navigation anchor for An author's replyAn author's replyShow More
As Dr Weinstein correctly points out, escalation of intervention does not reliably improve outcome.
As to why family medicine physicians would be willing to participate in obstetrics, given the potential for bad outcomes, we note that, although the majority of births in this country are attended by OBGYNs, family physicians and midwives still account for a significant number of births, especially in rural areas...
Competing Interests: None declared. - Page navigation anchor for Vaginal Childbirth--an extreme sportVaginal Childbirth--an extreme sportShow More
On March 27-29 2006 The NIH hosted a Conference on “State-of-the Science: Cesarean Delivery on Maternal Request. The problem was that there is no data on such requests, only that cesarean sections (CS) were rising 1 suggesting forces at play to consider CS as just another birth.
The Conference was preceded by a systematic review, relying on data incapable of separating out planned CS from planned vaginal birth...
Competing Interests: None declared. - Page navigation anchor for "P. T. Barnum - You were right on""P. T. Barnum - You were right on"Show More
As I am completing my 30th year as an obstetrician, my 25th year as a maternal fetal medicine specialist and my 14th year as a department Chair, I have seen many things change in the profession. Unfortunately, many of these profound changes have done little to truly improve mother or infant outcome. The profession of obstetrics has become a real "circus", with much more aggravation than satisfaction. I clearly do not un...
Competing Interests: None declared.