Effective Care for Pregnancy & Childbirth: Table #6 ~ Forms of care likely to be Ineffective or Harmful

Murray Enkin, MD, FRCS(C), L L D, Marc J. N. C Keirse, MD, DPhil, DPH, FRA NWOG, FRCOG
James Neilson, BSc, MD, FRCOG, Caroline Crowther, MD, DCH, DDU, FRCOG, FRANWOG,
Lelia Duley, MD, MSc(Epid), MRCOG, Ellen Hodnett, RN, PhD,
and G. Justus Hofmneyr, MBBCH, MRCOG

Third Edition ~ 2000

Editor’s Note: forms of care in table 6 are evaluated as “ineffective or harm demonstrated by clear evidence” thus the forms of care listed on this table are highly likely to be either ineffective or harmful. Forms of care “likely to be ineffective or harmful” should be formally acknowledged as such by the caregiver and “informed consent” should be obtain before they are employed.

In particular, the difference between ineffective but beneign treatment (for instance the advise to drink extra water to stop preterm labor) should be distinquished from those interventions that have great harm associated with them (such as scheduled Cesarean because the physician is trying to prevent possible should dystocia with all the well-known hazards of cesarean surgery / subsequent VBAC status).

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.

Table 6. Forms of Care Likely to be Ineffective or Harmful  Ineffective or harm demonstrated by clear evidence

“This evidence should encourage … the abandonment of those that are useless or harmful.”

Editor’s Note:  The status of these forms of care has been established as “ineffective or harmful” – a fact that should be formally acknowledged by the caregiver. Informed consent should be obtain before any of these forms of care are employed.

In particular, the difference between ineffective but beneign treatment (such as nipple creams or ointments for breastfeeding mothers) should be distinguished from interventions that have great harm associated with them (such as scheduled Cesarean to prevent possible should dystocia, with all the well-known hazards of cesarean surgery / VBAC status resulting from this massive intervention).

Basic care

  •  Dietary restrictions to prevent pre-eclampsia

Screening and diagnosis

  • Contraction stress cardiotocography {EFM}  to improve perinatal outcome
  • Nipple simulation test cardiotocography {EFM} to improve perinatal outcome
  • Non-selective use of non-stress cardiotocography {NST} to improve perinatal outcome

Pregnancy problems

  • Adrenocorticotrophic hormone (ACTH) for severe vomiting of pregnancy
  • Saline cathartics for constipation
  • Lubricant oils for constipation
  • Diethylstilbestrol {DES} during pregnancy
  • Elective delivery for prelabor rupture of the membranes preterm
  • Ethanol to stop preterm labor
  • Progestogens to stop preterm labor

Childbirth

  • Routine enema in labor
  • Routine pubic shaving in preparation for childbirth
  • Electronic fetal monitoring without access to fetal scalp sampling during labor
  • Prophylactic intrapartum amnioinfusion for oligohydrammos
  • Rectal examinations to assess labor progress
  • Requiring’ a supine (flat on back) position in the second stage of labor
  • Routine use of the lithotomy position for the second stage of labor
  • Routine or liberal episiotomy for birth
  • Ergometrine instead of oxytocin prophylaxis in the third stage of’ labor

Problems in childbirth

  • Glycero-impregnated catgut for repair of perineal trauma

Techniques of induction and operative delivery

  • Oral prostaglandins for cervical ripening
  • Estrogens for cervical ripening or for induction of labor
  • Oxytocin for cervical ripening before induction of labor

Care after childbirth

  • Sodium bicarbonate for asphyxiated babies
  • Routine restriction of mother-infant contact
  • Routine nursery care for babies in hospital
  • Antenatal Hoffman’s exercises for inverted or flat nipples
  • Antenatal breast shells for inverted or flat nipples
  • Limitation of suckling time during breastfeeding
  • Nipple creams or ointments for breastfeeding mothers
  • Routine supplements of water or formula for breastfed babies
  • Samples of formula for breastfeeding mothers
  • Encouraging fluid intake beyond demands of thirst for breastfeeding mothers
  • Combined estrogen-progesterone oral contraceptives for breastfeeding mothers
  • Test weighing of breastfed infants
  • Witchhazel for relief of perineal pain
  • Adding salt to bath water for treating perineal pain
  • Antiseptic solutions added to bath water for perineal pain
  • Hormones for relief of breast symptoms in non-breastfeeding mothers
  • Bromocriptine for relief of breast symptoms in non-breastfeeding mothers

Continue –> Cochrane databased synopsis of  research and recommendation for 2nd Labor Manegement