Women's Health Snapshots: Birthing
Factors such as physician attitudes and the patient's socioeconomic status may influence the decision to perform an episiotomy, the incision made in a woman's perineum to enlarge her vaginal opening for childbirth. For example, white women and women with private health insurance were at higher risk for episiotomy than non-whites and women without private insurance. Dr. Hueston suggests that providers may be more interventional with women they perceive as expecting perfect outcomes and are more likely to file malpractice suits. Midwives perform episiotomies in 39% of vaginal births, while obstetricians use the procedure in 68-79% of vaginal deliveries.
"Factors Associated with the Use of Episiotomy During Vaginal Delivery," by William J. Hueston, Obstetrics and Gynecology, June 1996, pp. 1001-1005.
In 1994 caesarean delivery accounted for 22% of births. This is the lowest rate since 1984 and the first significant decline since 1988 when the rate was 24.7%. As in previous years, caesarean rates differed by region of the country, age of the mother, type of hospital, and the expected source of payment for the delivery.
"Rates of Caesarian and VBAC Delivery, United States, 1994" by Sally C. Clarke, and Selma M. Taffel, Birth, September 1996, p. 166.
A third epidemiological study has linked electromagnetic fields to breast cancer. Patricia Coogan and colleagues at the Boston University School of Public Health reported a 43% increase in breast cancer among women with a high potential for occupational exposure to magnetic fields, notably those working with main frame computers. Importantly, only a small number of women were in the"high potential for exposure" category, so the reported risk may be imprecise.
Epidemiology, September 1996, pp. 459-464.
Women having trouble getting pregnant should stop smoking before beginning infertility treatment. Dr. Bradley J. Van Voorhis and colleagues at the University of Iowa found a 50% reduction in the pregnancy rate among women who smoked during their infertility treatment.
Obstetrics and Gynecology, November 1996, p. 785.
Research findings don't change practice patterns. When medical research has identified the most effective approaches to certain health problems, health practitioners habits don't change. Witness the overuse of mastectomy, routine ultrasound during pregnancy, and the failure of many physicians to treat ulcers with antibiotics. Typically, when the effectiveness or lack of a treatment is determined, written materials are produced to educate clinicians with the assumption that providing information will be sufficient to change clinicians' behavior. A recent meta-analysis found depressing results—of 11 high quality studies, only one showed a significant change in the behavior of clinicians after receiving educational materials. The reviewers concluded that the effects of printed educational materials are of "uncertain clinical significance". The over use of mastectomy, hysterectomy, episiotomy and routine ultrasound use during pregnancy are just a few examples of cases where consumer advocacy had more effect on practice than scientific studies. All the more reason for individual collective vigilance and activism!
Freemantle, N, et al. 'The effectiveness of printed educational materials in changing
the behavior of health care professionals." In The Cochrane Database of Systemic Reviews. Available in The Cochrane Library (database on disk and CDROM)