EDITOR'S NOTE:
This article is the text and six tables from the
final chapter (Chapter 50) of the new third edition of A Guide to Effective Care
in Pregnancy and Childbirth. It summarizes the authors' conclusions and
recommendations, based on the information they have compiled in the book about
the beneficial or harmful effects of the various elements of care used during
pregnancy, and childbirth.
The 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.
Research based
on the study of groups may riot 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.
Table 3. Forms
of Care with a Trade-off Between Beneficial and Adverse Effects
Women and
caregivers should weigh these effects according
to circumstances, priorities,
and preferences
Basic
care
Continuity of caregiver for childbearing women
Legislation restricting type of employment for pregnant
women
Screening
and diagnosis
Formal systems of risk scoring
Routine ultrasound in early pregnancy
Chorionic villus sampling versus amniocentesis for
diagnosis of chromosomal abnormalities
Scrum alpha‑fetoprotein screening for neural tube
defects
Triple‑test screening for Down syndrome and
neural tube defects
Pregnancy
problems
Corticosteroids, to promote fetal maturity before
preterm birth in diabetic pregnancy
Routine elective cesarean for breech presentation
Induction of labor for prelabor rupture of the
membranes at term
Oral betamimetics to maintain uterine quiescence after
arrest of preterm labor
Cervical cerclage for women at risk of preterm birth
Betamimetic drugs to stop preterm labor
Induction instead of surveillance for pregnancy after
41 weeks gestation
Expectant care versus induction of labor after fetal
death
Childbirth
Continuous electronic monitoring (with scalp sampling)
versus intermittent auscultation during labor
Milling versus mediolateral episiotomy, when episiotomy
is necessary
Prophylactic ergometrine /oxytocin
(syntometrine)
versus oxytocin alone in the third stage of labor
Problems
during childbirth
Routine preloading with intravenous fluids before
epidural analgesia
Narcotics to relieve pain in labor
Inhalation analgesia to relieve pain in labor
Epidural analgesia to relieve pain in labor
Epidural administration of opiates to relieve pain in
labor
Early amniotomy in spontaneous labor
Techniques
of induction and operative delivery
Mechanical methods for cervical ripening or induction
of labor
Endocervical versus vaginal prostaglandin for cervical
ripening before induction of labor
Oral prostaglandin L, for induction of labor with a
ripe cervix
Natural prostaglandins versus oxytocin for induction of
labor
Soft versus rigid vacuum extractor cups
Regional Versus general anaesthesia for cesarean
section
Epidural versus spinal anesthesia for cesarean section
Ampicillin versus broader spectrum antibiotics for
cesarean section
Care
after childbirth
Prophylactic antibiotic eye ointments to prevent eye
infection in the newborn
Prophylactic versus "rescue" surfactant for
very preterm infants
Continue
on to Table No. 4
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