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Table 6: Forms of Care Likely to be Ineffective or Harmful



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 6 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 fifth of these tables — Forms of care likely to be ineffective or harmful — 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 6. Forms of care likely to be ineffective or harmful

Ineffectiveness or harm demonstrated by clear evidence   Chapter

Basic care
Dietary restriction to prevent pre-eclampsia   6, 15

Screening and diagnosis
Contraction stress cardiotocography to improve perinatal outcome   12
Nipple-stimulation test cardiotography to improve perinatal outcome   12
Non-selective use of non-stress cardiotocography to improve perinatal outcome   12

Pregnancy problems
Adrenocorticotrophic hormone (ACTH) for severe vomiting of pregnancy   13
Saline cathartics for constipation   13
Lubricant oils for constipation   13
Diethylstilbestrol during pregnancy   14
Elective delivery for prelabor rupture of the membranes preterm   23
Ethanol to stop preterm labor   24
Progestogens to stop preterm labor   24

Childbirth
Routine enema in labor   29
Routine pubic shaving in preparation for childbirth   29
Electronic fetal monitoring without access to fetal scalp sampling during labor   30
Prophylactic intrapartum amnio-infusion for oligohydramnios   30
Rectal examinations to assess labor progress   31
Requiring a supine (flat on back) position in the second stage of labor   32
Routine use of the lithotomy position for the second stage of labor   32
Routine or liberal episiotomy for birth   32
Ergometrine instead of oxytocin prophylaxis in the third stage of labor   33

Problems in childbirth
Glycerol-impregnated catgut for repair of perineal trauma   36

Techniques of induction and operative delivery
Oral prostaglandins for cervical ripening   39
Estrogens for cervical ripening or for induction of labor   39
Oxytocin for cervical ripening before induction of labor   39

Care after childbirth
Sodium bicarbonate for asphyxiated babies   44
Routine restriction of mother-infant contact   45
Routine nursery care for babies in hospital   45
Antenatal Hoffman's exercises for inverted or flat nipples   46
Antenatal breast shells for inverted or flat nipples   46
Limitation of suckling time during breastfeeding   46
Nipple creams or ointments for breastfeeding mothers   46
Routine supplements of water or formula for breastfed babies   46
Samples of formula for breastfeeding mothers   46
Encouraging fluid intake beyond demands of thirst for breastfeeding mothers   46
Combined estrogen-progesterone oral contraceptives for breastfeeding mothers   46
Test weighing of breastfed infants   46
Witchhazel for relief of perineal pain   47
Adding salt to bath water for treating perineal pain   47
Antiseptic solutions added to bath water for perineal pain   47
Hormones for relief of breast symptoms in non-breastfeeding mothers   48
Bromocriptine for relief of breast symptoms in non-breastfeeding mothers   48


Most recent page update: 3/8/2006


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