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Related Experiment Videos

Do obstetric intranatal interventions make birth safer?

M Tew

    British Journal of Obstetrics and Gynaecology
    |July 1, 1986
    PubMed
    Summary

    Higher rates of perinatal mortality are linked to increased obstetric interventions in hospitals. Improved maternal health, not interventions, likely caused the historical decline in mortality rates.

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    Area of Science:

    • Obstetrics and Gynecology
    • Public Health
    • Perinatal Medicine

    Background:

    • Perinatal mortality rates have historically declined, with a concurrent rise in obstetric interventions and hospital births.
    • The prevailing belief attributes this decline to advancements in medical interventions and increased hospital utilization.

    Purpose of the Study:

    • To critically analyze the relationship between obstetric intranatal interventions and perinatal mortality.
    • To investigate the actual impact of interventions on perinatal mortality and birth outcomes.
    • To propose an alternative explanation for the observed decline in perinatal mortality rates.

    Main Methods:

    • Analysis of official statistics, national surveys, and specific studies.
    • Comparison of perinatal mortality rates between high-intervention hospital settings and low-intervention settings (general practitioner units, home births).
    • Statistical adjustments for pre-delivery risk status and predicted risk levels.

    Main Results:

    • Perinatal mortality is significantly higher in consultant hospitals with high intervention rates compared to midwife-led units or home births.
    • The decline in national perinatal mortality rates over 50 years is unlikely attributable to increased interventions; rates would have declined more without them.
    • Obstetric interventions are associated with increased incidence of low birthweight, short gestation, and associated mortality.

    Conclusions:

    • The current organization of maternity services, emphasizing interventions and hospitalization, is counterproductive to reducing perinatal mortality.
    • Improved maternal health over generations is a more plausible explanation for the historical decline in perinatal mortality.
    • Evidence suggests that obstetric interventions may adversely affect perinatal outcomes, contradicting established beliefs.

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