Evidence Based Medicine and Ob/Gyn

Unfortunately, some routine things in ob/gyn have little evidence. For example, fetal heart monitoring is standard of care today because of medicolegal precedent. Intuitively, monitoring the fetus' heart rate seems like a good idea; it's one of the few noninvasive ways we have of seeing how the fetus is doing. But there's no evidence suggesting that monitoring leads to better outcomes for mother or child. Indeed, the evidence suggests monitoring increases only one thing significantly: rates of c-sections (which we would like to avoid).

Indeed, how much medical intervention is appropriate in the process of childbirth? For thousands of years, women have been giving birth without the help of doctors. And they were doing well. Now is our medical meddling worthwhile? Is it beneficial for the mother and baby? Is it cost-effective? Certainly we would like to think we do no harm. But a hospital is an instutition, sterile and unwelcoming. Would women feel more comfortable delivering at home? Would babies do better in that environment?

To give credit where it is due though, Pap smears have the best evidence in my opinion of reducing cancer-related mortality. While there's never been a randomized controlled trial, the epidemiology, both in the U.S. and worldwide, is compelling.