Harm vs benefits of obstetric interventions

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I came across an article that said that  “Overuse of therapeutic procedures, diagnostic tests, and medications is an understudied problem that may account for as much as 30% of healthcare spending in the United States and result in harm to patients, according to a review published in the January 23 issue of the Archives of Internal Medicine.”

It did not specifically mention obstetrics, but I have a feeling that it would be the same sort of percentages.

From the article “Overuse was defined as interventions in which negative consequences, including unnecessary costs, outweighed the benefits of care.”

So what are some overused interventions in obstetrics….here’s the list that I came up with(these are just my thoughts, but based off of experience and reading):

1. Checking the cervix every hour or two…

Potential benefit…really it doesn’t do much except tell the doctor where you are right at that moment.  It doesn’t tell you where you will be even 5m from that point.

Potential harm…introducing infection, increasing costs(in time and materials and treatment of infection), rushing birth, pain for mother, anxiety or stress for mother.

2. Early induction for non medical reasons

Potential benefits…. convenience, perhaps relieve some stress and anxiety.

Potential harms…increase the use of other interventions, more painful, need to be continuously monitored, increased c-section rate, increased fetal heart rate abnormalities(increased cost in time and materials).

3. Routine artificial rupture of membranes(not medically indicated)

Potential benefits…slightly faster birth

Potential harms….increased fetal heart rate abnormalities, increased risk of infection, increased pain, mother uncomfortable with continuous leaking, (increased cost in time and materials).

4. Routine continuous monitoring(not medically indicated)

Potential benefits…doctors and nurses feel more comfortable, doctors and nurses feel more legally comfortable, takes less of the doctors and nurses time to monitor the heart rate

Potential harm….increase in c-section has been associated with continuous monitoring, more uncomfortable for mother, usually confined to bed, unable to utilize many other options to move around and provide comfort(increased cost in materials).

5. Routine use of IV fluids(not medically indicated)

Potential benefits…can get fluids in as fast as possible if an epidural is needed or desired, can give fluids quickly to help with with low blood pressure.

Potential harm…fluid overload, not able to move around as freely or easily(increased cost in time and materials).

Just looking at this list, our medical community wastes a lot of money on interventions that are neither necessary nor desired.  Of course, money is not the bottom line.  But these interventions have the potential to do harm with not a lot of benefits.  Just my humble opinion.

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