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Synopsis TablesThe full text of A Guide to Effective Care in Pregnancy and Childbirth
(Oxford University Press, 2000) is freely available on this website
courtesy of the authors: Murray Enkin, Marc J.N.C. Keirse, James
Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus
Hofmeyr. (A separate page provides information about this Guide.)
The narrative from the final chapter is reproduced below. This chapter is a synopsis of the entire book (and field), including 6 tables classifying hundreds of maternity practices according to effectiveness and safety. The six numbered links below will take you to pages that reproduce the six tables. Links in the tables will lead you to the chapters that discuss specific maternity practices. Chapter 50. Effective Care in pregnancy and childbirth: a synopsisThe underlying thesis of this book is that evidence from well-controlled comparisons provides the best basis for choosing among alternative forms of care in pregnancy and childbirth. This evidence should encourage the adoption of useful measures and the abandonment of those that are useless or harmful.In this final chapter we have tried to summarize the main conclusions reached in earlier chapters. This summary takes the form of six tables which list, respectively: Tables 1 and 6 are based on clear evidence from systematic reviews of randomized controlled trials. Tables 2 and 5 are based on information from reviews of controlled trials or good observational evidence, but for which the conclusions can not be as firmly based as those for Tables 1 and 6. Table 3 lists forms of care with both beneficial and adverse effects, which women and caregivers should weigh according to their individual circumstances and priorities; and Table 4 lists forms of care for which there are insufficient data, or data of inadequate quality on which to base a recommendation. We have tried to be explicit about our criteria for choosing which table to use for each intervention, but there is inevitably some subjectivity in our choice. We worked from two basic principles: first, that the only justification for practices that restrict a woman's autonomy, her freedom of choice, and her access to her baby, would be clear evidence that these restrictive practices do more good than harm; and second, that any interference with the natural process of pregnancy and childbirth should also be shown to do more good than harm. We believe that the onus of proof rests on those who advocate any intervention that interferes with either of these principles. A tabulated summary such as this is necessarily selective. Nuances discussed in the chapters cannot find full expression in summary tables. Nevertheless, we hope that the explicit form in which these conclusions have been stated will be useful, and that the advantages of this summary approach will outweigh its drawbacks. The inclusion of a particular form of care in Tables 1 or 2 does not imply that it should always be adopted in practice. Research based on the study of groups may not always apply to individuals, although it should be relevant to guide broad policies of care. Forms of care listed in Tables 5 and 6 may still be useful in particular circumstances, although, once again, they should be discouraged as a matter of policy. Practices listed in Table 3 will require careful consideration by the individuals concerned, while those in Table 4 should usually be avoided except in the context of trials to better evaluate their effects. Some of the conclusions that we have reached will be controversial, but they must be judged in the light of the methods we used to assemble and review the evidence on which they are based. While we have made great efforts to ensure that the data presented are comprehensive and accurate, it is possible that errors and misinterpretations have crept in. We conclude by reiterating the invitation extended to readers in our first edition, to bring omissions and mistakes to our attention for inclusion and correction in The Cochrane Library and in later editions of this book. Correspondence should be addressed to the Cochrane Pregnancy and Childbirth Group, Liverpool Women's Hospital NHS Trust, Crown Street, Liverpool, UK L8 7SS. [Continue to Table 1. Beneficial forms of care from the synopsis chapter.] Most recent page update: 3/8/2006
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Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families. |
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