Women's Health

The Oxford team’s research revealed that the surgery and suturing involved in an episiotomy lead to more bleeding, infection, and tearing of tissue than when no episiotomy is done.
As for cesarean deliveries, there is mounting evidence that more than half of all C-sections performed in this country may be unnecessary.
In the United States, C-sections exceed 30 percent of all births. In England, they total 9 percent. As do many American researchers, the Oxford team says that there is no reason to rule out natural vaginal birth for a mother just because she has had a cesarean.
How did the Oxford team members arrive at the findings? They focused on studies on childbearing done from 1950 onward that were published in 60 key scientific journals, then wrote to the authors of these studies and to 18,000 obstetricians to obtain unpublished data.
Finally, they subjected the studies to meticulous mathematical evaluations. In particular, they were looking for research that used random and controlled techniques.
For example: Suppose a researcher wants to evaluate the safety and effectiveness of shaving pubic hair before birth. (Such an experiment was conducted in 1922.) As women come through the hospital, they are assigned by a coin toss: shaved or not shaved. That makes their selection random, eliminating bias in selection. The effects are evaluated later by individuals unaware of who was and was not shaved: they were “blinded” with respect to who received what. This prevents conscious or unconscious bias. The unshaved patients become the comparison or control patients. A statistician later sums up the results. If there is no difference between shaved and unshaved patients -as the 1922 test concluded – then shaving should be abandoned. (Of course, in any trial, if the number of subjects is too small, it cannot be concluded that there was no difference between them.)
Frederick Mosteller of Harvard University, one of the nation’s leading statisticians, strongly endorses the Oxford methods. “I am very impressed with the magnitude and strength of the effort and experts brought into play,” he says. “One of the things I like about their work is that they cared deeply whether the patient was pleased. This more tender and humanitarian interest is quite surprising in a book concerned with quantitative analysis. They emphasized letting the patient participate in decisions.”
Despite the findings of the Oxford team and others, many obstetricians and pediatricians -especially those with practices away from large research centers – have been slow to change their methods.
“I am shocked that 10 percent of Canadian hospitals still shave women,” says Dr. Enkin, “or did so until very recently. Though the story on shaving has long been known, doctors didn’t change their habits until women began to complain and ask why it was being done.”
“If a doctor believes that our data do not tell the truth,” Dr. Keirse asserts, “then that critic must mount his own randomized, blinded, controlled trials to prove he is right and we are wrong.”
Daniel M. Fox heads the Milbank Memorial Fund, based in Manhattan, which is sponsoring conferences and an information network to encourage putting the study’s results to work.
“As the medical world learns more of what this Oxford team has done,” Mr. Fox says, “there could be a revolution in obstetrical practice. And that could save many babies and mothers, and billions of dollars.”
Here are some other new views their research has provided:
•     Diet and pregnancy-induced hypertension (pre-eclampsia). There is no evidence that dietary intervention prevents this condition.
•      Routine use of iron supplements. It is unnecessary and probably harmful.
•      Giving steroid hormones to mothers in labor to relieve breathing problems in their low-weight babies. Proponents say this could save billions by replacing more costly care for the infants later.
As the Oxford team’s work gains recognition, it seems logical that we will be seeing more infants born at home or in birthing centers, attended to by mid-wives or physicians’ assistants. Hospitals will provide emergency backup for births, but their primary role will be to provide care for high-risk patients.
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WOMEN’S HEALTH