I think it would be interesting to quantify 'a lot' and to look at immediate and longer term effects. For example, the ARRiVE trial shows a reduction in pre-eclampsia for women, which is in itself a good thing, arguably - but actually, the earlier women are induced, the less pre-eclampsia they will have, but the unintended consequences go up the earlier this is done, for mother and baby. So though we might be able to say, accurately, that inducing all women at 32 weeks gestation will reduce preeclampsia rates, Im pretty sure no maternity system would put this into place, given the wide range of other adverse consequences this policy would generate for mother and for baby.
So, for example, perinatal mortality is lower, but the adverse consequences of earlier and earlier intervention, and less and less physiological birth, have to be put in the mix. The term breech trial shows a reduction in the composite adverse outcome measure at the time of birth for babies in the CS arm - but overall mortality was not present when outcomes at two years were compared. We can always make a case for something if we define it narrowly and only look at very specific time periods that may favour our case - but this is a bit disingenuous in terms of the overall wellbeing of all women and babies over that time period if we dont look at the total picture of benefits and harms for all. We owe a duty of care to all women and all babies, and the wellbeing of all in the short and longer term depends on a range of outcomes that occur over time, and that all need to be considered if we are to defend one approach or another to maternity care, in my view.
All the best
Soo
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From: A forum for discussion on midwifery and reproductive health research.
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