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Women’s Health Risks Associated With Orthodox Medicine – Part I

During the past century, a medical establishment has evolved that has positioned itself as the exclusive provider of so-called scientific, evidence based therapies. For the first 70 years of the 20th century, little effort was made to challenge the establishment’s paradigm, which we call the orthodox medical approach. In the past 30 years, however, there has been a growing awareness of the importance of an alternative approach to medical care, one that, either on its own or as a complement to orthodox medicine, emphasizes nontoxic and noninvasive treatments and prevention.

Unfortunately, this new perspective has been fought vigorously. We’ve been told that it is only the treatments of orthodox medicine that have passed careful scientific scrutiny involving double-blind placebo-controlled studies. We’ve also been told that alternative or complementary health care does not have any science to back it up, only anecdotal evidence. These two ideas have led to the widely accepted “truths” that anyone offering an alternative or complementary approach is depriving patients of the proven benefits of safe and effective care, and that people not only do not get well with alternative care but actually are endangered by it.

With this report, we question the status quo in one area of orthodox medicine: practices related to women’s health. Our review of the medical literature shows that the safety and effectiveness of many orthodox treatments cannot be assumed. We present dozens of research summaries which reveal that conventional treatments may not deliver the expected benefits or may be associated with an increased risk of various health disorders.

This review will be presented in several parts, covering topics ranging from the use of oral contraceptives to surgical practices such as hysterectomies and cesarean sections. In this section, we focus on antenatal care, fetal heart monitoring, and home versus hospital deliveries.

Note that all of the studies included in this report come from mainstream medicine’s own respected journals, such as the Journal of the American Medical Association and The Lancet. There is nothing subjective or political about the conclusions drawn here. The criticism of various therapies in this series comes not from the “alternative” world but from the very heart of orthodox medicine itself.

The journal articles speak for themselves. We are a society that claims to live by the gold standard of scientific research, but this report shows that statement to be at odds with reality. It shows that we routinely cause iatrogenic conditions and unnecessary suffering—as well as waste vast sums of money—through a systemic negligence of the facts. This situation must be challenged and remedied.

Antenatal Care

If you assume that more prenatal care equals better pregnancy outcomes, the following research reports may come as a surprise. Several studies have found that fewer prenatal visits to the doctor or fewer medical procedures resulted in similar or better outcomes than more visits or more care.

Other studies show that routine ultrasound screening of low-risk women does not translate to improved health in newborns. And when it comes to detecting cases of Down’s syndrome, traditional screening by ultrasound and maternal age is just as effective as the more costly method of blood serum screening.

The results of this study, conducted on over 57,000 women, show that those who received the most amount of prenatal care by their physicians had the worst pregnancy outcomes and the highest rate of cesarean sections and induced labor.

—Gissler M, Hemminki E, Amount of antenatal care and infant outcome. Eur J Obstet Gynecol Reprod Biol 1994 Jul; 56(1):9-14.

The results of this study show that the introduction of a new program of prenatal care consisting of an average of 2.7 fewer than usual prenatal visits was associated with maternal and infant outcomes that were similar to those of women receiving standard number of prenatal visits.

—McDuffie RS Jr, Beck A, Bischoff K, Cross J, Orleans M, Effect of frequency of prenatal care visits on perinatal outcome among low-risk women. A randomized controlled trial. JAMA 1996 Mar 20; 275(11):847-51.

This randomized study, conducted on approximately 16,000 women in Zimbabwe, evaluated the effects of a new prenatal program for pregnant women consisting of fewer physician visits (an average of 4 instead of 6 visits), and fewer medical procedures per visit, on maternal and infant outcomes. Women who received less prenatal visits and less medical procedures had significantly lower risk of delivering preterm babies and of experiencing severe hypertension and eclampsia. Other outcomes were similar in the two groups.

—Munjanja SP, Lindmark G, Nystrom L, Randomised controlled trial of a reduced-visits programme of antenatal care in Harare, Zimbabwe. Lancet 1996 Aug 10; 348(9024):364-9.

The results of this study show that routine ultrasound screening during pregnancy is not associated with improved newborn health. The study was conducted on 15,151 low-risk pregnant women randomized into two groups. Women in the first group received two ultrasound tests during their pregnancy, those in the second group received an ultrasound scan only if their doctor saw a specific medical need for the exam. No differences in perinatal outcome were detected between the two groups, indicating that routine ultrasound screening in low-risk women may increase health care costs without improving the health of women and their newborns.

—Ewigman BG, Crane JP, Frigoletto FD, LeFevre ML, Bain RP, McNellis D, Effect of prenatal ultrasound screening on perinatal outcome. RADIUS Study Group. N Engl J Med 1993 Sep 16; 329(12):821-7.

The results of this study show that routine ultrasonographic screening in low-risk pregnant women is not associated with higher rates of abortion for congenital anomalies or with improved health outcomes of infants born with treatable malformations.

—Crane JP, et al., A randomized trial of prenatal ultrasonographic screening: impact on the detection, management, and outcome of anomalous fetuses. The RADIUS Study Group. Am J Obstet Gynecol 1994 Aug; 171(2):392-9.

The results of this study show that blood serum screening, introduced as the most effective screening method for Down’s syndrome since 1993, is no more effective than traditional screening by ultrasound and maternal age at detecting cases of Down’s syndrome, and is significantly more costly. The retrospective study was conducted on all women who gave birth at one institution in the period 1993 to 1998. Overall, there were 31,259 deliveries, including 53 cases of Down’s syndrome. The traditional method of screening using maternal age in combination with ultrasound scans detected 68% cases of Down’s syndrome, corresponding to the same effectiveness of screening through blood markers. Traditional screening has been replaced by blood screening based on the unverified assumption that traditional screening could only detect one-third of Down’s cases. This study, however, demonstrates that the benefits of blood screening may be much less than supposed, and undermines the costs-benefit arguments for it.

—DT Howe, et al., Six year survey of screening for Down’s syndrome by maternal age and mid-trimester ultrasound scans. BMJ 2000; 320:606-610 (4 March).

Fetal Heart Monitoring

Electronic monitoring of fetal heart rates gets a negative report card from the research presented here in terms of its ability to improve fetal outcomes. These studies suggest that the practice is unnecessary and perhaps harmful.

One study found that fetal heart monitoring does not lead to a reduced incidence of neurological complications or perinatal mortality, while another found that premature babies monitored electronically have a worse neurological outcome than those monitored with periodic auscultation.

Electronic fetal monitoring also is associated with an increased rate of cesarean deliveries and a low Apgar score,8 which is a numerical rating of a baby’s health immediately after delivery.

This article emphasizes that, despite early results from uncontrolled trials documenting the beneficial effects of fetal monitoring, randomized trials have consistently failed to demonstrate its efficacy in improving fetal outcome. Electronic monitoring of fetal-heart rates does not result in a decreased incidence of neurological complications or perinatal mortality and is, therefore, unnecessary.

—Kaiser G, Do electronic fetal heart rate monitors improve delivery outcomes? J Fla Med Assoc 1991 May; 78(5):303-7.

This article presents evidence from randomized controlled trials indicating that fetal heart rate monitoring does not improve fetal outcome, and its use is therefore unjustified.

—Parer JT, King T, Fetal heart rate monitoring: is it salvageable? Am J Obstet Gynecol 2000 Apr; 182(4):982-7.

The results of this study indicate that premature babies who undergo electronic fetal heart rate monitoring have a worse neurological outcome, compared to those monitored with periodic auscultation. In the study, 189 premature babies were randomly assigned to either electronic fetal monitoring or periodic auscultation. Neurological assessment performed at the age of 4, 8, and 18 months revealed that babies monitored electronically had lower mental- and psychomotor-development scores, compared to those monitored by periodic auscultation. In addition, babies who underwent electronic monitoring had a 2.5- fold increased incidence of cerebral palsy, compared to those followed by auscultation. Median time to delivery after the recognition of an abnormal heart rate pattern was 104 minutes in babies monitored electronically and 60 minutes in those monitored by auscultation. These data indicate that fetal heart monitoring is ineffective in improving neurological outcome in prematurely born babies, and its use may be associated with harm.

—Shy KK, et al., Effects of electronic fetal-heart-rate monitoring, as compared with periodic auscultation, on the neurologic development of premature infants. N Engl J Med 1990 Mar 1; 322(9):588-93.

The results of this study show that electronic fetal monitoring does not improve delivery outcome, while being associated with an increased rate of cesarean deliveries and low Apgar score.

—McCusker J, Harris DR, Hosmer DW Jr., Association of electronic fetal monitoring during labor with Cesarean section rate and with neonatal morbidity and mortality. Am J Public Health 1988 Sep; 78(9):1170-4.

Home Versus Hospital Delivery

The medical literature offers some encouraging news about the option of delivering at home. A handful of studies, most published since 1995, attest to the safety and effectiveness of home deliveries.

These studies attribute a variety of positive results to midwife-managed care. In one study, the risk of infant and neonatal death and the likelihood of delivering a low-birth-weight baby were lower in midwife-attended births, compared with physicianattended births. Another study found that women in midwife-attended deliveries were less likely to undergo a cesarean section and that fewer diagnoses of fetal distress were made.

In total, the studies point to less intervention in midwife- assisted deliveries. A 1996 study in The Lancet found that labor was initiated less often in women attended by midwives only than in women attended by physicians and midwives. Significantly more women were satisfied with the midwife-managed care than with the care managed by a physician and midwife.

The results of this study show that the pregnancy outcome of women who delivered their first baby at home is as good as that of women who gave birth to their first baby in the hospital. On the other hand, women who gave birth to at least one child and planned to deliver at home had significantly better pregnancy outcomes than those who planned to deliver in the hospital, indicating that home delivery is as safe, or safer, than hospital delivery.

—Wiegers TA, Keirse MJ, van der Zee J, Berghs GA, Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in The Netherlands. BMJ 1996 Nov 23; 313(7068):1309-13.

This letter was written in reply to an article published on the Times of May 20, describing hospital delivery as being 3 times safer than home delivery. The letter emphasizes that the author of the Times article compared data from different countries to reach his conclusions, although data were actually not comparable. Evaluation of the National Birthday Trust survey of home births in the U.K., a certainly more appropriate approach to the question of safety of home versus hospital delivery, shows that within a group formed by 3,896 women who delivered at home, there was only one neonatal death (occurring from 0 to 27 days after birth) and no stillbirths, compared to 2 neonatal deaths and 2 stillbirths in a control group of similar, low-risk women who delivered in the hospital. The author concludes that there is no evidence indicating that home delivery carries more risk than hospital delivery in properly screened women. The letter emphasizes that women should receive accurate, up-to-date information, so that they may properly choose between home and hospital delivery.

—Chamberlain G, Choosing between home and hospital delivery. Risk of home birth in Britain cannot be compared with data from other countries. Letter. BMJ 2000; 320:798 (18 March).

This randomized study, conducted on 1,299 low-risk pregnant women, evaluated pregnancy outcome in women attended by midwives only, or by a combination of midwives, hospital doctors and general physicians. Labor was initiated significantly more often in women followed by physicians and midwives than in those followed by midwives only (33.3% vs. 23.9% of cases). Women attended only by midwives were more likely to have an intact perineum and less likely to undergo episiotomy (surgical enlargement of the vulval orifice during delivery). Perineal tears and rate of complications were similar in the two groups. Significantly more women expressed satisfaction with the midwife-managed care than with the physician-midwife managed care.

—Turnbull D, et al., Randomised, controlled trial of efficacy of midwife-managed care. Lancet 1996 Jul 27; 348(9022):213-8.

The results of this study, conducted on all women who in 1991 delivered by the vaginal route a single baby at 35-43 weeks gestation, show that the risk of infant and neonatal death is 19% and 33% lower, respectively, in midwife-attended births compared to physician-attended births. The likelihood of delivering a low-birth-weight infant is 31% lower in midwife- versus physician-assisted deliveries. These results suggest that delivery care provided by midwives may be superior to that provided by physicians.

—MacDorman MF, Singh GK, Midwifery care, social and medical risk factors, and birth outcomes in the USA. J Epidemiol Community Health 1998 May; 52(5):310-7.

The results of this study show that women attended by midwives are 30% less likely to undergo cesarean section compared to those attended by physicians. Furthermore, a diagnosis of fetal distress is made 50% less often in babies delivered by midwives, compared to those delivered by physicians.

—Butler J, Abrams B, Parker J, Roberts JM, Laros RK Jr., Supportive nurse-midwife care is associated with a reduced incidence of Cesarean section. Am J Obstet Gynecol 1993 May; 168(5):1407-13.

The results of this study show that pregnancy outcomes in women whose pregnancy has been followed by midwives are similar to those of women followed by obstetricians, indicating that routine visits of low-risk pregnant women by obstetricians are unnecessary. Women who experienced complications during labor were promptly recognized by midwives and transferred to obstetrician care.

—Law YY, Lam KY, A randomized controlled trial comparing midwife-managed care and obstetrician-managed care for women assessed to be at low risk in the initial intrapartum period. J Obstet Gynaecol Res 1999 Apr; 25(2):107-12.

The results of this study show that pregnancy outcomes in women who choose to deliver at home and are attended by midwives are similar to those of women who choose to deliver in hospital and are attended by obstetricians. Women who delivered at home received significantly less medication and fewer medical interventions, compared to those who delivered in the hospital. In the case of complications or suspected complications, women were transferred to the hospital and were followed up by obstetricians.

—Ackermann-Liebrich U, et al., Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome. Zurich Study Team. BMJ 1996 Nov 23; 313(7068):1313-8.

By Gary Null, Ph.D., Debora Rasio, M.D. and Martin Feldman, M.D.