BMJ 2002;324:928-929 ( 20 April )

Editorials

Promoting evidence based practice in maternal care

Would keep the knife away

Papers pp 942, 945

The first 150 words of the full text of this article appear below.

In maternal health care there is a recognised gap between evidence of effectiveness and clinical practice. Indeed, too often routine care is not evidence based and there is strong resistance to stopping harmful or useless procedures.1 Unnecessary caesarean section and episiotomy are good examples of the mismatch between evidence and practice and of the complexities that change entails, as two articles in this issue illustrate. 2 3

Unnecessary caesarean section is known to increase health risks for both mother and newborn child and adds burdens to healthcare budgets. There has been a sustained growth in caesarean section rates worldwide that has reached epidemic proportions in Latin America. A combination of factors contributes to this trend: providers' views on the safety of caesarean section,4 obstetricians' convenience,5 and the configuration of healthcare systems.6 A fourth element is patients' demand for surgical delivery, a hotly debated issue, especially in Brazil.

Contrary to anecdotal evidence that . . . [Full text of this article]
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This article has been cited by other articles:

  • Regan, M., Liaschenko, J. (2007). In the Mind of the Beholder: Hypothesized Effect of Intrapartum Nurses' Cognitive Frames of Childbirth Cesarean Section Rates. Qual Health Res 17: 612-624 [Abstract]  
  • Sridhar, C B, Suresh, D. (2003). Model for Bangalore helped disseminate information to doctors in India. BMJ 326: 337-337 [Full text]  
  • Potter, J. E, Hopkins, K., Bettiol, H., Barbieri, M. A., da Silva, A. A. M., Rona, R. J., Begley, C. M (2002). Consumer demand for caesarean sections in Brazil. BMJ 325: 335-335 [Full text]  

Rapid Responses:

Read all Rapid Responses

Ask women, not researchers, for birth's truest answers
Leilah McCracken
bmj.com, 21 Apr 2002 [Full text]
Promoting evidence based practice in maternal care
Donna Young, et al.
bmj.com, 21 Apr 2002 [Full text]
Demand for caesareans should be assessed rather than inferred
Joseph E Potter, et al.
bmj.com, 22 Apr 2002 [Full text]
No change
Bernard H Fookes
bmj.com, 23 Apr 2002 [Full text]
Nurses Stop Looking the Other Way
Carolyn Rafferty
bmj.com, 23 Apr 2002 [Full text]
Natural function, not an illness
Bonnie B. Matheson
bmj.com, 24 Apr 2002 [Full text]
Remote consequences of Caesarean section
Martin Quinn
bmj.com, 24 Apr 2002 [Full text]
Financial and Non-Financial Reasons
William D. Savedoff
bmj.com, 24 Apr 2002 [Full text]
Caesarean section: misinformed choice or lack of alternatives ?!
Hora Soltani, et al.
bmj.com, 25 Apr 2002 [Full text]
The Missing link?
Jennifer s. Hall
bmj.com, 25 Apr 2002 [Full text]
casarian section more misused than used
Badakere c Rao, et al.
bmj.com, 25 Apr 2002 [Full text]
Time for adequate counselling
Dr.Geeta.K. Tadimalla
bmj.com, 26 Apr 2002 [Full text]
Paternalism and political correctness
Richard D Seigne
bmj.com, 14 May 2002 [Full text]
Improving quality of childbirth experience may reduce demand for Caesarean sections.
Helen J Smith, et al.
bmj.com, 15 May 2002 [Full text]
Enrich health care resources through midwifery
Laura Cao-Romero
bmj.com, 30 Jun 2002 [Full text]
Spread of World Health Organization Reproductive Health Library Information to Doctors in India
Sridhar CB, et al.
bmj.com, 20 Nov 2002 [Full text]
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