Category: Obstetrics & gynecology

Questioning the Annual Pelvic Exam

A new article in the Journal of Women’s Health by Westhoff, Jones, and Guiahi asks “Do New Guidelines and Technology Make the Routine Pelvic Examination Obsolete?” The pelvic exam consists of two main components: the insertion of a speculum to visualize the cervix and the bimanual exam where the practitioner inserts two fingers into the vagina and puts the other hand on...

/ March 1, 2011

Childbirth Without Pain: Are Epidurals the Answer?

Is unmedicated natural childbirth a good idea? The American College of Obstetrics and Gynecology (ACOG) points out that There is no other circumstance in which it is considered acceptable for a person to experience untreated severe pain, amenable to safe intervention, while under a physician’s care. It is curious when an effective science-based treatment is rejected. Vaccine rejecters have been extensively discussed...

/ February 15, 2011

Home Birth Safety

More and more American women (1 in 200) are opting for home birth, and midwife-assisted home birth is common in other developed countries. How safe is it compared to birth in a hospital? A new study sheds some light on the subject. It was recently published in the American Journal of Obstetrics and Gynecology: Maternal and newborn outcomes in planned home birth...

/ August 3, 2010

Alcohol and Pregnancy

We know that drinking alcohol during pregnancy can cause birth defects; the government-mandated warnings on alcoholic beverage labels constantly remind us of that fact. But toxicologists remind us that the poison is in the dose: what is the dose of alcohol that causes birth defects? Heavy drinking can cause fetal alcohol syndrome, but there is no evidence that light to moderate drinking...

/ May 18, 2010

Acupuncture for Depression

One of the basic principles of science-based medicine is that a single study rarely tells us much about any complex topic. Reliable conclusions are derived from an assessment of basic science (i.e prior probability or plausibility) and a pattern of effects across multiple clinical trials. However the mainstream media generally report each study as if it is a breakthrough or the definitive...

/ March 3, 2010

Abortion and breast cancer: The manufactroversy that won’t die

Whatever one thinks about abortion from a moral standpoint, we at SBM would argue that any discussion of the risks of abortion should be based in rigorous science. One "risk" of abortion frequently claimed by antiabortion activists is that it causes breast cancer, even if it takes science as bad as that found in a recently published epidemiological "study" on abortion and...

/ January 18, 2010

Is breech vaginal delivery safe?

Between 3-4% of babies begin labor in the breech (bottom first) position, increasing the risk of neonatal morbidity and mortality. Pre-emptive C-section has become the preferred method of delivery for breech babies, but now some are questioning this recommendation. The controversy is fueled by differing appraisals of the danger and by differing assessments of the whether any risk of neonatal death can...

/ January 14, 2010

Are the benefits of breastfeeding oversold?

As a mother, I am a passionate advocate of breastfeeding and I breastfed my four children. As a clinician, though, I need to be mindful not to counsel patients based on my personal preferences, but rather based on the scientific evidence. While breastfeeding has indisputable advantages, the medical advantages are quite small. Many current efforts to promote breastfeeding, while well meaning, overstate...

/ December 17, 2009

Midwives and the assault on scientific evidence

The new mantra of midwives and their advocates is “evidence based practice.” Lamaze, the childbirth education organization has changed the name of their blog to “Science and Sensibility” emphasizing the importance of science and promising: Lamaze education and practices are based on the best, most current medical evidence available, and can help reduce the overuse of unnecessary interventions while improving overall outcomes...

/ December 10, 2009

A critique of the leading study of American homebirth

Its authors boast that it is one of the ten most downloaded papers from the British Medical Journal (BMJ). That makes it even more unfortunate that the conclusions of the paper are directly at odds with the findings of the paper. Outcomes of planned home births with certified professional midwives: large prospective study in North America by Kenneth Johnson and Bettye Ann...

/ December 3, 2009