Friday, September 14, 2007

Throwing the Mother out with the Bathwater

Nope, not my Title. I attended this session at Lamaze with Dr. Michael Klein. I was taking notes on his speech, I bought the CD and I'm still not sure I'm getting all of the nuances, but I wanted to point some things out before time passed...and I'm in an airport at 6:48am.

This session was a talk on Randomized Controlled Studies and how they are misused.
*In a matched cohort of healthy women, one hospital had a 8% cesarean rate, the other a 20% rate (early 1990's...don't we wish that was now!)
Cesarean rates with women having epidurals: 15.4% in the one low hospital and 67.2% in the other. The odds were 3.4x higher. In the low risk hospital, epidurals weren't given until later in labor, typically. The interesting thing is that with women having NO epidural in both hospitals, the cesarean rate was about the same and the women having an epidural in both hospitals, the risk of a cesarean was about the same. Dr Klein states that we don't know that it's causal, but it's a dang good coincidence, eh?

(Janssen P, Klein MC Differences in Institutional Cesarean Rates: The role of Pain Management. J Fam Pract 2001, 50(3) 217-223)

*His research survey also showed some correlation with epidurals and newborn outcomes. The higher the epidural rate, the lower the apgars in newborns and the more newborns in the NICU.
Interestingly, he notes that physicians who spent more time with their patients, even though their patients were in the hospital for a shorter period of time and used epidurals later..had better outcomes.

*universiality cannot be conferred by an RCT, even if done WELL. A small hospital with three doctors ad 1000 births per year is not going to have the same type of situation as a hospital with 30 physicians and 25K births per year. (my numbers, pulled out of my hat.)

More on the Next Blog Entry. :)

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