Editorials

Promoting evidence based practice in maternal care

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7343.928 (Published 20 April 2002) Cite this as: BMJ 2002;324:928

Would keep the knife away

  1. Ana Langer (alanger@popcouncil.org.mx), regional director,
  2. Jos Villar, coordinator, maternal health research
  1. Population Council, Latin America and Caribbean Office, Escondida 110, Mexico City 04000, Mexico
  2. Department of Reproductive Health and Research, World Health Organization, 1211 Geneva 27, Switzerland

    Papers pp 942, 945

    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. …

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