The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #62051

Kenneth C Johnson, PhD, Epidemiologic Consultant, 36 Glen Ave, Ottawa, ON K1S 2Z7, Canada, 613 730 0282, Ken_LCDC_Johnson@HC-SC.GC.CA and Betty-Anne Daviss, RM, CPM, MA, The Midwifery Collective of Ottawa, 36 Glen Ave, Ottawa, ON K1S 2Z7, Canada.

Over the last two decades obstetrical evidence has benefited greatly from the Cochrane Collaboration. Through it meta-analysis is used to marshal research from the worldwide medical literature to formulate prudent evidence-based recommendations for care. Unfortunately, the obstetrical community in North America has often chosen to ignore that evidence where the recommendation involved less intervention in birth, for example abandoning routine electronic monitoring or restricting the use of episiotomy.

An even more disturbing trend in the use of obstetrical research appears to have developed recently. Studies of questionable merit are being used in isolation rather as part of a synthesis of the literature. In particular, two new studies, one on VBAC and the other on home birth, of questionable scientific merit, are being used outside the spirit and modern scientific principles set forth by the Cochrane Collaboration. The VBAC study is based on hospital admission-discharge administrative records that lack the sensitivity or specificity of diagnosis needed for careful comparison. It also failed to look at natural comparison groups and single layer suturing in Caesarean Section may be an issue.

The home birth study is also based on administrative data which lack the detail to accurately access the care providers at home births. Despite these research shortcomings, both studies were published in high profile journals, given strong media attention (one, even before publication) and have had undue impact on obstetrical practice in North America. American maternity care needs to adopt the evidence-based model provided by the Cochrane Collaborative.

Learning Objectives:

• At the conclusion of the session, the participant (learner) in this session will be able to:
• 1.List three aspects of the Cochrane collaboration methods that make it so valuable scientificlly.
• 2.Describe the three shortcomings in the Pang homebirth study and why its makes the study inapporiate for generalization to homebirth safety.
• 3.Describe the issues surrounding the VBAC contraversey with respect to the Lydon-Rochelle study.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.