Spin-doctoring obstetrical research

A funny thing happened on the way to practicing evidence-based obstetric care. Obstetricians hijacked some of the research. In the late 1970s and 1980s advocates for change could say either that the evidence did not exist to support typical obstetric management or that it existed and discredited it.  Enough people made this point that governmental agencies, third-party payers, and consumers began pressuring obstetricians to mend their ways. To cite one example, the Healthy People goals set in 1990 mandated a reduction in the cesarean delivery rate to 15 percent by 2000 (1). (It is worth noting that the National Institutes of Health convened a consensus conference in 1980to strategize on how to lower a cesarean rate that had reached the alarming heights of 15 percent [2].)

Mainstream obstetricians reacted, not by bringing their practices into line with what the research showed to be safe and effective care, but by fighting change. In a variation of the old saw ‘‘If it looks like a duck and sounds like a duck and walks like a duck, it’s a duck,’’ they discovered that if a study read like a well-done study—it was laid out as such, used the right terminology and concepts, and was published in a peer-reviewed journal—it would be accepted into the canon of evidence-based care and could be used to shape policy, even if it was junk.

This exercise pulled the rug out from under birth activists. It was hard enough trying to explain to an unsophisticated public and clinicians that expert opinion was insufficient without science to back it up.  Convincing them that research published in respected medical journals might be fatally flawed or that claims for it were not justified is well-nigh impossible. Once misinformation is widely disseminated, a well-crafted rebuttal has little effect. The damage is done, and the fact that the falsehood aligns with the cultural zeitgeist, whereas the correction does not, ensures that it cannot be undone.  Some examples follow…


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