Table 1: Beneficial Forms of Care | A Guide to Effective Care in Pregnancy and Childbirth

Table 1: Beneficial Forms of Care

The full text of A Guide to Effective Care in Pregnancy and Childbirth (Oxford University Press, 2000) is freely available on this website courtesy of the authors: Murray Enkin, Marc J.N.C. Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr. (A separate page provides information about this Guide.)

Table 1 from the final chapter is reproduced below. The final chapter, a synopsis of the entire book (and field), includes 6 tables classifying hundreds of maternity practices according to effectiveness and safety. The first of these tables — Beneficial forms of care — is reproduced in full below. The links in the table lead to the chapters that discuss the specific maternity practices.

Chapter 50. Effective care in pregnancy and childbirth: a synopsis

Table 1. Beneficial forms of care

Effectiveness demonstrated by clear evidence from controlled trials

Chapter

Basic care

Women carrying their pregnancy record to enhance their feeling of being in control

Pre- and peri-conceptional folic acid supplementation to prevent recurrent neural tube defects

5, 6

Folic acid supplementation (or high folate diet) for all women envisaging pregnancy

5, 6

Assistance (especially behavioral strategies) to stop smoking during pregnancy

Balanced energy and protein supplementation when dietary supplementation is required

Vitamin D supplementation for women with inadequate exposure to sunlight

Iodine supplementation in populations with a high incidence of endemic cretinism

Screening and diagnosis

Doppler ultrasound in pregnancies at high risk of fetal compromise

Pregnancy problems

Antihistamines for nausea and vomiting of pregnancy that is resistant to simple measures

Local imidazoles for vaginal candida infection (thrush)

Local imidazoles instead of nystatin for vaginal candida infection (thrush)

Magnesium sulphate rather than other anticonvulsants for treatment of eclampsia

Administration of anti-D immunoglobulin to Rh-negative women whose newborn baby is not Rh-negative

Administration of anti-D immunoglobulin to Rh-negative women at 28 weeks of pregnancy

Antiretroviral treatment of HIV-infected pregnant women to prevent transmission to fetus

Antibiotic treatment of asymptomatic bacteriuria

Antibiotics during labor for women known to be colonized with group B streptococcus

Tight as opposed to too strict or loose control of blood sugar levels in pregnant diabetic women

External cephalic version at term to avoid breech birth

Corticosteroids to promote fetal maturity before preterm birth

Offering induction of labor after 41 completed weeks of gestation

Childbirth

Physical, emotional and psychological support during labor and birth

28, 35, 41

Continuous support for women during labor and childbirth

Agents to reduce acidity of stomach contents before general anesthesia

Complementing fetal heart-rate monitoring in labor with fetal acid-base assessment

Oxytocics to treat postpartum hemorrhage

Prophylactic oxytocics in the third stage of labor

Active versus expectant management of third stage of labor

Problems during childbirth

Absorbable instead of non-absorbable sutures for skin repair of perineal trauma

Polyglycolic acid sutures instead of chromic catgut for repair of perineal trauma

Techniques of induction and operative delivery

Prostaglandins to increase cervical readiness for induction of labor

Amniotomy plus oxytocin for induction of labor instead of either amniotomy alone or oxytocin alone

Vacuum extraction instead of forceps when operative vaginal delivery is required

Antibiotic prophylaxis (short course or intraperitoneal lavage) with cesarean section

Care after childbirth

Use of surfactant for very preterm infants to prevent respiratory distress syndrome

Support for socially disadvantaged mothers to improve parenting

Consistent support for breastfeeding mothers

Personal support from a knowledgable individual for breastfeeding mothers

Unrestricted breastfeeding

Local anesthetic sprays for relief of perineal pain postpartum

Cabergoline instead of bromocriptine for relief of breast symptoms in non-breastfeeding mothers

Table 2. Forms of care likely to be beneficial

Most recent page update: 3/8/2006

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