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74.5% of Obstetrican Recommendations are not Science or Evidence based.

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Quote:

Scientific Evidence Underlying the American College of Obstetricians and Gynecologists' Practice Bulletins

Wright, Jason D. MD; Pawar, Neha MD; Gonzalez, Julie S. R. MD; Lewin, Sharyn N. MD; Burke, William M. MD; Simpson, Lynn L. MD; Charles, Abigail S. MS; D'Alton, Mary E. MD; Herzog, Thomas J. MD

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Abstract

OBJECTIVE: Clinical guidelines are an important source of guidance for clinicians. Few studies have examined the quality of scientific data underlying evidence-based guidelines. We examined the quality of evidence that underlies the recommendations made by the American College of Obstetricians and Gynecologists (the College).

METHODS: The current practice bulletins of the College were examined. Each bulletin makes multiple recommendations. Each recommendation is categorized based on the quality and quantity of evidence that underlies the recommendation into one of three levels of evidence: A (good and consistent evidence), B (limited or inconsistent evidence), or C (consensus and opinion). We analyzed the distribution of levels of evidence for obstetrics and gynecology recommendations.

RESULTS: A total of 84 practice bulletins that offered 717 individual recommendations were identified. Forty-eight (57.1%) of the guidelines were obstetric and 36 (42.9%) were gynecologic. When all recommendations were considered, 215 (30.0%) provided level A evidence, 270 (37.7%) level B, and 232 (32.3%) level C. Among obstetric recommendations, 93 (25.5%) were level A, 145 (39.7%) level B, and 117 (34.8%) level C. For the gynecologic recommendations, 122 (34.7%) were level A, 125 (35.5%) level B, and 105 (29.8%) level C. The gynecology recommendations were more likely to be of level A evidence than the obstetrics recommendations (P=.049).

CONCLUSION: One third of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence.

LEVEL OF EVIDENCE: III

http://journals.lww.com/greenjournal/Abstract/2011/09000/Scientific_Evidence_Underlying_the_American.3.aspx

In case you didn't catch it, for only obstetric recommendations, Level A (25.5%) is based on good and consistent evidence, Level B (39.7%) is based on limited or inconsistent evidence, and Level C (34.8%) is based on consensus and opinion.  This means that 74.5% of all obstetric recommendations in this study were made based on something other than science or evidence-based medicine.  Only 25.5% of obstetric recommendations were science and evidence based.

Better make sure you do your homework :)

It will be interesting to see what affect this study has.  I really wish I could read the whole thing, but a subscription costs $400 bucks!

by on Nov. 23, 2011 at 4:04 PM
Replies (11-17):
FromAtoZ
by AllieCat on Nov. 23, 2011 at 9:20 PM

We cannot read the entire article.

I cannot comment on something I cannot fully read.  *shrug*

As for your question above, I believe personal experience is important and most certainly comes in to play.  What a study says, or the stats, are not enough for me at times. 

I am going to feel more comfortable with any doctor who has actually handled situations, performed services, etc., versus one who 'goes by the book' and next to nothing else.

Grandmax2Momof4
by New Member on Nov. 23, 2011 at 9:36 PM
1 mom liked this
Very Interesting!!!
kailu1835
by Ruby Member on Nov. 23, 2011 at 11:42 PM

 I agree.  My point in using vaginal breech birth is because doctors tend to immediately turn to ceserean when it is shown that a baby is breech at full term.  The reason for this seems to be because of the fear of the things that can happen for some breech births.  One doctor I spoke to when I was looking for a caregiver for my first pregnancy had only delivered 3 breech births, and all 3 had problems.  She had delivered over 500 babies vaginally, but only 3 were breech.  Because those 3 had problems, she stopped doing breech births.  But that isn't necessarily evidence based.  I do want to say that I understand completely why she would not want to do them anymore if she hadn't had any positive experiences, but her experience is not the majority, and should not necessarily have a big bearing on a woman's decision to birth a breech baby vaginally.  This is why I ask... should a doctor's personal experience outweigh the science when making recomendations?  Or should the doctor's experience lead him or her to suggest to the patient that they look at a different provider for the experience they are looking for?

Quoting jllcali:

If a doctor kept delivering babies breech that died or had birth related injuries to include anoxic brain injury, never having a positive outcome, the research and science should be telling him he is doing something wrong, and figure out what it is.

Quoting kailu1835:

 I'm not disagreeing with you, because I believe that a doctor having personal knowledge can be extremely helpful when helping a patient come to a decision. 


My question to further the discussion in this direction is this: If a person's personal experience directly contradicts what is science and evidence based, do you think that experience should dictate the doctor's recommendation over the evidence?  In other words, if a doctor has never delivered a vaginal breech with a positive outcome, yet science shows that only a small percentage of babies born vaginally breech have negative outcomes, do you think that the doctor's personal experience outweigh the statistics?


Quoting Mommy_of_Riley:

And...

I'm glad not everything is a "well the study says this."

Knowledge from practice and experience are GOOD to have as well.

 

 

CAluv
by Bronze Member on Nov. 24, 2011 at 2:51 AM

 I must say that most doctors that I've crossed path with just plain don't do their job, so I'd guess that makes for a large proportion of them that can't be bothered to use their training.

**********
When you believe in things that you don't understand
Then you suffer
Superstition ain't the way
**********

jllcali
by Jane on Nov. 24, 2011 at 3:12 AM
Did this doctor try a version (external manuvers to change the position of the baby in the uterus) in any of these cases? Most babies will turn head down by the 36th week. So if a baby is breech and has not turned by then, in most cases version is good to try. Waiting much after that, and there isn't a lot of room for the baby to revert to breech.

Quoting kailu1835:

 I agree.  My point in using vaginal breech birth is because doctors tend to immediately turn to ceserean when it is shown that a baby is breech at full term.  The reason for this seems to be because of the fear of the things that can happen for some breech births.  One doctor I spoke to when I was looking for a caregiver for my first pregnancy had only delivered 3 breech births, and all 3 had problems.  She had delivered over 500 babies vaginally, but only 3 were breech.  Because those 3 had problems, she stopped doing breech births.  But that isn't necessarily evidence based.  I do want to say that I understand completely why she would not want to do them anymore if she hadn't had any positive experiences, but her experience is not the majority, and should not necessarily have a big bearing on a woman's decision to birth a breech baby vaginally.  This is why I ask... should a doctor's personal experience outweigh the science when making recomendations?  Or should the doctor's experience lead him or her to suggest to the patient that they look at a different provider for the experience they are looking for?


Quoting jllcali:

If a doctor kept delivering babies breech that died or had birth related injuries to include anoxic brain injury, never having a positive outcome, the research and science should be telling him he is doing something wrong, and figure out what it is.


Quoting kailu1835:


 I'm not disagreeing with you, because I believe that a doctor having personal knowledge can be extremely helpful when helping a patient come to a decision. 



My question to further the discussion in this direction is this: If a person's personal experience directly contradicts what is science and evidence based, do you think that experience should dictate the doctor's recommendation over the evidence?  In other words, if a doctor has never delivered a vaginal breech with a positive outcome, yet science shows that only a small percentage of babies born vaginally breech have negative outcomes, do you think that the doctor's personal experience outweigh the statistics?



Quoting Mommy_of_Riley:

And...

I'm glad not everything is a "well the study says this."

Knowledge from practice and experience are GOOD to have as well.


 


 

Posted on CafeMom Mobile
kailu1835
by Ruby Member on Nov. 24, 2011 at 3:27 AM

 I did not ask, I had just asked if she delivered breech babies and when she said no, I asked why and that was the reason she gave me.  She pretty much shut down.  She was NOT the doctor I went to.  A few doctors that I interviewed said it was too risky.  I was born breech, so I knew it was possible (in most cases), and I also knew from studies that cesereans did not affect outcome of breech birth, negatively or positively, so I wasn't going to use a doctor who refused outright to allow vaginal breech birth.  I ended up using a midwife who had a backup doctor who would not rule out vaginal breech birth (midwives aren't allowed to deliver known breech births) on sight.  That was the best I could ask for, which is pretty sad.  Most doctors who DO allow vaginal breech births in my area will refuse if its a first time mom, even though there is no science or evidence to back this up :(

They tried to turn me a week before I was born (I was 10 days overdue), but it wasn't successful.  All of the studies I've seen say that you can do versions up to and during labor even, safely, but several people I know who had a ceserean due to breech did not have the doctor try version right before doing a ceserean.  I would like to see the rate of attempts go up.

Quoting jllcali:

Did this doctor try a version (external manuvers to change the position of the baby in the uterus) in any of these cases? Most babies will turn head down by the 36th week. So if a baby is breech and has not turned by then, in most cases version is good to try. Waiting much after that, and there isn't a lot of room for the baby to revert to breech.

Quoting kailu1835:

 I agree.  My point in using vaginal breech birth is because doctors tend to immediately turn to ceserean when it is shown that a baby is breech at full term.  The reason for this seems to be because of the fear of the things that can happen for some breech births.  One doctor I spoke to when I was looking for a caregiver for my first pregnancy had only delivered 3 breech births, and all 3 had problems.  She had delivered over 500 babies vaginally, but only 3 were breech.  Because those 3 had problems, she stopped doing breech births.  But that isn't necessarily evidence based.  I do want to say that I understand completely why she would not want to do them anymore if she hadn't had any positive experiences, but her experience is not the majority, and should not necessarily have a big bearing on a woman's decision to birth a breech baby vaginally.  This is why I ask... should a doctor's personal experience outweigh the science when making recomendations?  Or should the doctor's experience lead him or her to suggest to the patient that they look at a different provider for the experience they are looking for?


Quoting jllcali:

If a doctor kept delivering babies breech that died or had birth related injuries to include anoxic brain injury, never having a positive outcome, the research and science should be telling him he is doing something wrong, and figure out what it is.


Quoting kailu1835:


 I'm not disagreeing with you, because I believe that a doctor having personal knowledge can be extremely helpful when helping a patient come to a decision. 



My question to further the discussion in this direction is this: If a person's personal experience directly contradicts what is science and evidence based, do you think that experience should dictate the doctor's recommendation over the evidence?  In other words, if a doctor has never delivered a vaginal breech with a positive outcome, yet science shows that only a small percentage of babies born vaginally breech have negative outcomes, do you think that the doctor's personal experience outweigh the statistics?



Quoting Mommy_of_Riley:

And...

I'm glad not everything is a "well the study says this."

Knowledge from practice and experience are GOOD to have as well.


 


 

 

jllcali
by Jane on Nov. 24, 2011 at 4:18 AM
The closer to 40 weeks, the lower the sucess rate of a version. Also, the success rate of versions is lower in first time moms.

Quoting kailu1835:

 I did not ask, I had just asked if she delivered breech babies and when she said no, I asked why and that was the reason she gave me.  She pretty much shut down.  She was NOT the doctor I went to.  A few doctors that I interviewed said it was too risky.  I was born breech, so I knew it was possible (in most cases), and I also knew from studies that cesereans did not affect outcome of breech birth, negatively or positively, so I wasn't going to use a doctor who refused outright to allow vaginal breech birth.  I ended up using a midwife who had a backup doctor who would not rule out vaginal breech birth (midwives aren't allowed to deliver known breech births) on sight.  That was the best I could ask for, which is pretty sad.  Most doctors who DO allow vaginal breech births in my area will refuse if its a first time mom, even though there is no science or evidence to back this up :(


They tried to turn me a week before I was born (I was 10 days overdue), but it wasn't successful.  All of the studies I've seen say that you can do versions up to and during labor even, safely, but several people I know who had a ceserean due to breech did not have the doctor try version right before doing a ceserean.  I would like to see the rate of attempts go up.


Quoting jllcali:

Did this doctor try a version (external manuvers to change the position of the baby in the uterus) in any of these cases? Most babies will turn head down by the 36th week. So if a baby is breech and has not turned by then, in most cases version is good to try. Waiting much after that, and there isn't a lot of room for the baby to revert to breech.


Quoting kailu1835:


 I agree.  My point in using vaginal breech birth is because doctors tend to immediately turn to ceserean when it is shown that a baby is breech at full term.  The reason for this seems to be because of the fear of the things that can happen for some breech births.  One doctor I spoke to when I was looking for a caregiver for my first pregnancy had only delivered 3 breech births, and all 3 had problems.  She had delivered over 500 babies vaginally, but only 3 were breech.  Because those 3 had problems, she stopped doing breech births.  But that isn't necessarily evidence based.  I do want to say that I understand completely why she would not want to do them anymore if she hadn't had any positive experiences, but her experience is not the majority, and should not necessarily have a big bearing on a woman's decision to birth a breech baby vaginally.  This is why I ask... should a doctor's personal experience outweigh the science when making recomendations?  Or should the doctor's experience lead him or her to suggest to the patient that they look at a different provider for the experience they are looking for?



Quoting jllcali:

If a doctor kept delivering babies breech that died or had birth related injuries to include anoxic brain injury, never having a positive outcome, the research and science should be telling him he is doing something wrong, and figure out what it is.



Quoting kailu1835:



 I'm not disagreeing with you, because I believe that a doctor having personal knowledge can be extremely helpful when helping a patient come to a decision. 




My question to further the discussion in this direction is this: If a person's personal experience directly contradicts what is science and evidence based, do you think that experience should dictate the doctor's recommendation over the evidence?  In other words, if a doctor has never delivered a vaginal breech with a positive outcome, yet science shows that only a small percentage of babies born vaginally breech have negative outcomes, do you think that the doctor's personal experience outweigh the statistics?




Quoting Mommy_of_Riley:

And...

I'm glad not everything is a "well the study says this."

Knowledge from practice and experience are GOOD to have as well.



 



 


 

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