I am overjoyed to see this discussion continue like this. Someone mentioned why are all these routine birth practices done in hospital when many seem unnecessary?
  The Cochrane Collaboration, an internationally recognized research organization, provides meta-analysis and literature reviews on medical research in all areas and they have a huge data bank of Obstetric reviews. What’s sad and shocking is that obstetric medicine is, of all the medical disciplines, the least evidence based. What that means is that basically, the standard of care on how to treat gallstones is more supported by research than the standard on management of prolonged rupture of membranes!!
  www.cochrane.org
  As far as accountability goes, the health care pracitioner should be held accountable whenever they provide care that is NOT evidence based practice, but to who?? The AMA? The hospital? The insurance companies? The mother and baby who they harm with their "care"?
  The first 3 are actually recognized as entities to whom docs are accountable- let’s say if they want to bring a mom in for induction as 37 weeks – they better provide a diagnosis for the insurance company, check with the hospital for room availablity and staff and they might glance at their AMA protocols once in awhile- but, and this is my professional experience for the last 9 years, they think of mom/baby LAST and only for a brief moment and certainly not as a priority- although they will use the guilt trip of "We don’t want to wait until the baby gets into real trouble" whenever they feel like doing a c-section, esp if its getting close to dinner time, and this implies that all along, they’ve been thinking about that precious baby!!!!
  I tell my hospitals 35-40% c-section rate to all of my breastfeeding classes and mention inductions, birth practices, etc. More than once, I’ve had moms stay after class to talk with me about natural childbirth, and in good conscience, I refer them to a birthing center or mention homebirth, as, in my humble opinion, the hospital is pretty much the unsafest place to have a baby- oh yes- and now there is more research to support THAT notion as well!
   
  But, we are dealing with the majority of women who feel more comfortable and safe with hospital birth They should be informed and encouraged to get the most normal birth experience possible, with minimal interventions/disturbing the natural. Unfortunately, with the misinformation they receive from medical experts and their PCPs, many of them beg for primary c-sections and most beg for inductions and epidurals– so we have to work with what we got!
  Mary Herrington, RN
  Labor & Delvery
  St. Luke’s CMC
  The Woodlands, Texas



		
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