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The future of intrapartum care: navigating the perfect storm—an obstetrician's odyssey

Published:April 20, 2009DOI:https://doi.org/10.1016/j.ajog.2009.03.019
      Fellow officers, members, and guests, it is a humbling privilege to address you as the 71st president of this venerable society. Although I wear size-12 shoes, I am following in the very large footprints of the eminent presidents who have preceded me. 2009 will be a significant year in my life. It will mark my 40th year as a physician and my eligibility for Medicare and Social Security. By year's end, I will retire from the full-time practice of obstetrics and will deliver the last of thousands of babies. I have watched the evolution of “modern obstetrics” and the birth and death of technologies intended to make the birth process safer for mothers and infants. The timeliness of this talk is highlighted by a recent review of 41 common practices in labor and delivery.
      • Berghella V.
      • Baxter J.K.
      • Chauhan S.P.
      Evidence-based labor and delivery management.
      Only 4 had strong evidence based on data from scientific trials to support their recommendation while the vast majority either lacked supportive data or should not be offered based on available trial outcomes. I will now take you on an obstetrician's odyssey during which we will encounter the “perfect storm” of current intrapartum care.
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      References

        • Berghella V.
        • Baxter J.K.
        • Chauhan S.P.
        Evidence-based labor and delivery management.
        Am J Obstet Gynecol. 2008; 199: 445-454
        • Banta H.D.
        • Thacker S.B.
        Assessing the costs and benefits of electronic fetal monitoring.
        Obstet Gynecol Surv. 1979; 34: 627-642
        • Pello L.C.
        • Rosevear S.K.
        • Dawes G.S.
        • Moulden M.
        • Redman C.W.
        Computerized fetal heart rate analysis in labor.
        Obstet Gynecol. 1991; 78: 602-610
        • National Institute of Child Health and Human Development Research Planning Workshop
        Electronic fetal heart rate monitoring: research guidelines for interpretation.
        Am J Obstet Gynecol. 1997; 177: 1385-1390
        • American College of Obstetricians and Gynecologists
        Intrapartum fetal heart rate monitoring: ACOG practice bulletin no. 62.
        Obstet Gynecol. 2005; 105: 1161-1168
        • Thacker S.B.
        • Stroup D.
        • Chang M.
        Continuous electronic fetal heart rate monitoring for fetal assessment during labor.
        Cochrane Database Syst Rev. 2009; 1 (CD00962)
        • Garite T.J.
        • Dildy G.A.
        • McNamara H.
        • Nageotte M.P.
        • Boehm F.H.
        • Dellinger E.H.
        A multicenter controlled trial of fetal pulse oximetry in the intrapartum management of nonreassuring fetal heart rate patterns.
        Am J Obstet Gynecol. 2000; 183: 1049-1058
        • Bloom S.L.
        • Spong C.Y.
        • Thom E.
        • et al.
        Fetal pulse oximetry and cesarean delivery.
        N Engl J Med. 2006; 355: 2195-2202
        • Westgate J.A.
        • Harris M.
        • Curnow J.S.
        • Greene K.R.
        Randomized trial of cardiotocography alone or with ST waveform analysis for intrapartum monitoring.
        Lancet. 1992; 340: 194-198
        • Amer-Wahlin I.
        • Hellsten C.
        • Noren H.
        • et al.
        Intrapartum fetal monitoring; cardiotocography versus cardiotocography plus ST analysis of the fetal ECG: a Swedish randomized controlled trial.
        Lancet. 2001; 358: 534-538
        • Hankins G.D.
        • Rowe T.F.
        Operative vaginal delivery–year 2000.
        Am J Obstet Gynecol. 1996; 175: 275-282
        • Towner D.
        • Castro M.A.
        • Eby-Wilkens E.
        • Gilbert W.M.
        Effect of mode of delivery in nulliparous women on neonatal intracranial injury.
        N Engl J Med. 1999; 341: 1709-1714
        • Hannah M.E.
        • Hannah W.J.
        • Hewson S.A.
        • Hodnett E.D.
        • Daigal S.
        • Willan A.R.
        • Term Breech Trial Collaborative Group
        Planned cesarean section versus planned vaginal birth for breech presentation at term: a randomized multicenter trial.
        Lancet. 2000; 356: 1375-1383
        • Lydon-Rochelle M.
        • Holt V.L.
        • Easterling T.R.
        • Martin D.P.
        Risk of uterine rupture during labor among women with a prior cesarean delivery.
        N Engl J Med. 2001; 345: 3-8
        • Greene M.F.
        Vaginal delivery after cesarean section—is the risk acceptable?.
        N Engl J Med. 2001; 345: 54-55
        • O'Driscoll K.
        • Foley M.
        • MacDonald D.
        Active management of labor as an alternative to cesarean section for dystocia.
        Obstet Gynecol. 1984; 63: 485-490
        • Frigoletto F.D.
        • Lieberman E.
        • Lang J.M.
        • et al.
        A clinical trial of active management of labor.
        N Engl J Med. 1995; 333: 745-750
        • American College of Obstetricians and Gynecologists
        Induction of labor: clinical management guidelines for obstetrician-gynecologists.
        November 1999
        • American College of Obstetricians and Gynecologists
        Evaluation of cesarean delivery.
        2000 (Washington, DC)
        • Harer Jr, W.B.
        A look back at women's health and ACOG, a look forward to the challenges of the future.
        Obstet Gynecol. 2001; 97: 1-4
        • Feldman G.B.
        • Freiman J.A.
        Prophylactic cesarean section at term?.
        N Engl J Med. 1985; 312: 1264-1267
      1. National Institutes of Health state-of-the-science conference statement: cesarean delivery on maternal request, March 27-29, 2006.
        Obstet Gynecol. 2006; 107: 1386-1397
        • MacLennan A.
        • Nelson B.
        • Hankings G.
        • et al.
        Who will deliver our grandchildren?.
        JAMA. 2005; 204: 1688-1690
        • Committee on Quality of Health Care in America
        To err is human: building a safer health system.
        National Academy Press, Washington, DC1999
        • Weinstein L.
        The laborist: a new focus for the obstetrician.
        Am J Obstet Gynecol. 2003; 188: 310-312