Steve Calvin M.D. on pregnancy care, health care reform, and innovation

Evidence-based maternity care

If you want to understand labor and its variations I highly recommend reading the excellent comprehensive summary by Rebecca Dekker PhD RN APRN from the University of Kentucky:

When we admit the error of our obstetrical ….

Cesarean section rates have doubled over the last 25 years.    This has occurred without evidence of benefit to mothers or babies.  In fact, the increase in rates has been physically and financially detrimental.    There are some key causes of the increased resort to the surgical delivery of babies.  One is the belief that there is an ideal pattern of labor and delivery and that deviation is dangerous.   Since the 1950s obstetrical care has been guided by a faulty understanding of normal labor.  Emmanuel Friedman gave us the Friedman labor curve as a template that we have imposed on all mothers giving birth.

My little part in this perpetuation of error included teaching medical students that all mother’s should have their labor progress plotted on the curve and that deviation required “active” management of labor.  This led to unnecessary Pitocin and cesarean sections when progress didn’t fit the curve.  We should have known better.   Over the last few years academic medicine has started to recognize the error of our ways.   A great recent summary of this comes from my medical school alma mater, Washington University in St. Louis.  Alison Cahill does a nice job summarizing the information:

This is why I am so happy to be involved with a new model of pregnancy and birth care.  At the Minnesota Birth Center our great midwives recognize that most labors are normal – even those that don’t follow the Friedman curve.  When abnormalities occur it is important to recognize and intervene, however it is often a good idea to just give a mom and baby a new position, a warm tub of water, and some time.    It helps to recognize that the current conventional wisdom isn’t always current (or wise).