Current Resources for Evidence-Based Practice, September/October 2015.

Abstract

Standardizing Evidence-Based Perinatal Practice Amid the Medical Malpractice Threat I recently had a conversation with a fellow midwife in which she discussed a frustrating encounter she had with a collaborating physician regarding her care of a woman receiving labor augmentation for premature rupture of membranes. The physician was concerned about the woman’s rate of cervical dilation and expressed his opinion that she should have a cesarean if she did not give birth vaginally in the next few hours. The midwife cited a recent obstetric care consensus (American College of Obstetricians and Gynecologists & Society for Maternal-Fetal Medicine, 2014) as evidence to support her recommendation that the woman have more time to complete latent-phase labor in the presence of normal maternal and fetal monitoring results. The physician was dismissive of this evidence and told the midwife, “No new study or guideline is going to save us if anything goes wrong with this baby. I’m not risking a medical malpractice case over this.” Later, the midwife was pessimistic about evidence-based practice as she discussed the conversation with me, “Does it even matter if we have scientific evidence about clinical practice, when the only thing guiding our decision making is the fear of a medical malpractice claim?”