Excerpts from “Evidence Based Maternity Care”

From the Milbank Memorial Fund and Childbirth Connection, here are a few excerpts from the latest studies on maternity care in the US:

Many maternity practices that were originally developed to address specific problems have come to be used liberally and even routinely in healthy women. Examples include labor induction, epidural analgesia, and cesarean section. These interventions are experienced by a large and growing proportion of childbearing women; are often used without consideration of alternatives; involve numerous co-interventions to monitor, prevent, or treat side effects; are associated with risk of maternal and newborn harm; and greatly increase costs. Mothers, babies, and purchasers would benefit from giving priority to effective, safer care paths and using risky interventions for well-supported indications only or when other measures are inadequate. The following practices would instead be consistent with the framework of this report: avoiding induction for convenience; using labor support, tubs, and other validated nonpharmacologic pain relief measures and stepping up to epidurals only if needed; and applying the many available measures for promoting labor progress before carrying out cesarean section for “failure to progress.” Such protocols would require considerable change in many settings, but would lead to a notable reduction in the use of more consequential procedures and an increase in cost savings. Available systematic reviews also do not support the routine use of other common maternity practices, including numerous prenatal tests and treatments, continuous electronic fetal monitoring, rupturing membranes during labor,
and episiotomy.

Systematic reviews also clarify that many effective maternity practices with modest or no known adverse effects are underutilized. Greater fidelity in providing these forms of care would lead to improved outcomes for many mothers and babies. In pregnancy, such care includes prenatal vitamins, smoking cessation interventions, measures for preventing preterm birth, and hands-to-belly maneuvers to turn fetuses to a head-first position before birth. The many beneficial, underused practices around the time of birth include continuous labor support, numerous measures that increase comfort and facilitate labor progress, nonsupine positions for giving birth, delayed cord clamping, and early mother-baby skin-to-skin contact. Best available evidence also supports providing access to vaginal birth after cesarean (VBAC) for most women with a previous cesarean. Systematic reviews also identify many strategies for increasing both establishment and duration of breastfeeding and effective ways to treat postpartum depression.”


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