Inappropriate use of randomised trials to evaluate complex phenomena: case study of vaginal breech delivery

Department of Obstetrics and Gynaecology, University of British Columbia, BC Women's Hospital, Vancouver, BC, V6H 3V5 Canada.
BMJ (online) (Impact Factor: 16.38). 10/2004; 329(7473):1039-42. DOI: 10.1136/bmj.329.7473.1039
Source: PubMed
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    ABSTRACT: Choice and control for birthing women have recently come under the global spotlight as a human rights issue, and are likely to remain so while midwives are being targetted for providing home birth care. While focussing on these issues appears to further widen the dichotomy between medicine and midwifery, understanding how this divide is maintained is necessary if we are to move beyond it. This article, utilising Foucault’s theory of genealogy, recapitulates how midwifery knowledge came to be subjugated by a dominant medical discourse, particularly through the process of hospitalising birth. The submission of the Australian Medical Association to a government enquiry into maternity services is then examined to illustrate how discourse is perpetuated, and how medicine still configures itself as the dominant birth discourse in Australia. The importance of focussing on midwifery specific knowledge, using the notion of embodiment, is put forward.
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    ABSTRACT: Background In many countries, planned vaginal breech birth (VBB) is a rare event. After the Term Breech Trial in 2000, VBB reduced and caesarean section for breech presentation increased. Despite this, women still request VBB. The objective of this study was to explore the experiences and decision-making processes of women who had sought a VBB. Methods A qualitative study using descriptive exploratory design was undertaken. Twenty-two (n = 22) women who planned a VBB, regardless of eventual mode of birth were recruited. The women had given birth at one of two maternity hospitals in Australia that supported VBB. In-depth, semi-structured interviews using an interview guide were conducted. Interviews were analysed thematically. Results Twenty two women were interviewed; three quarters were primiparous (n = 16; 73%). Nine (41%) were already attending a hospital that supported VBB with the remaining women moving hospitals. All women actively sought a vaginal breech birth because the baby remained breech after an external cephalic version – 12 had a vaginal birth (55%) and 10 (45%) a caesarean section after labour commenced. There were four main themes: Reacting to a loss of choice and control, Wanting information that was trustworthy, Fighting the system and seeking support for VBB and The importance of ‘having a go’ at VBB. Conclusions Women seeking a VBB value clear, consistent and relevant information in deciding about mode of birth. Women desire autonomy to choose vaginal breech birth and to be supported in their choice with high quality care.
    BMC Pregnancy and Childbirth 04/2015; 15(1). DOI:10.1186/s12884-015-0521-4 · 2.15 Impact Factor
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