Norsigian and Rooks on Evidence-Based Labor and Delivery

June 25, 2009

In November 2008, The American Journal of Obstetrics & Gynecology published a review, Evidence-based labor and delivery management, that looked at the quality of the evidence used to support labor and birth practices. In response to the review, nurse-midwife and epidemiologist Judith Rooks and OBOS Executive Director Judy Norsigian wrote a letter to the editor that was published in the May 22, 2009 issue of AJOG.

In it, Norsigian and Rooks note that while the review “makes an important contribution to the care of healthy women having normal labors,” it is problematic because “Berghella’s ‘D’ grade (‘fair evidence that harms outweigh benefits’) for home-like births in hospitals was skewed by their decision not to review the evidence on many frequently used obstetric interventions, some of which (eg, induction) can cause harm when they are overused.”

If you have access to AJOG, the authors have responded to “agree that midwife-led models of care for labor and delivery should be encouraged, based on the recent Cochrane metaanalysis” and that they “support future randomized trials to compare” the options of home vs. hospital births.

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