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What (Hype) to Reject When You're Expecting: Reviewing Consumer Report's Report

Posted Sep 20 2012 12:36pm
Thanks to a fellow concerned consumer of the parenting literature we now have yet another reason to question the health advice dispensed from that well-respected non-profit consumer agency (aka Consumer Reports).  She emailed:

Hi Polly,

A friend posted this to her FB wall and I just saw in your recent post about how Consumer Reports had such a bias in their reporting on the Stanford organic foods study and I thought to myself how this is the second time this week I have read something crazy biased come out of CR. What's with those guys? Just wanted to know what you thought about this article. (What to Reject When You're Expecting: 10 Procedures to Think Twice about During Your Pregnancy)

-Andrea

Dear Andrea,

Thank goodness Consumer Reports is providing pregnant women with medical recommendations because there's simply not enough advice out there. 

Unless of course you count the actual medical experts, medical organizations, baby websites, parenting books, mommy blogs and every other man, woman or television doctor telling pregnant women what to do or not do. 

-Polly


Since when does Consumer Reports dole out medical advice?

Reviewing C-section outcomes and such are a far cry from rating the suctioning power of vacuum cleaners. Whoever wrote the article that irked Andrea (there's no name attached, an unpaid intern perhaps or other person herein known as Anonymous) seemed to lose interest with solid evidence about half-way through, incidentally about the point I started to lose my normally congenial disposition.

In other words, what we have here is yet another less than stellar expose on the perils foisted upon women and children, in this case, the unnecessary medical procedures related to pregnancy, labor and delivery.

True, mortality rates among infants and women giving birth are depressingly high in the US. We get it. The infant mortality rate is increasing, driven by increasing rates of premature and low-birth-weight babies. Maternal deaths are increasing too. A spokesperson from the March of Dimes says it's partly due to unhealthier moms with no further elaboration but I suspect she's referring to obesity and a dearth of prenatal care. Anonymous also blames the maternal and infant deaths in addition to a host of disturbing consequences to primarily the rise of C-sections, medically unnecessary ones.  He/She also was considerate enough to come up with 9 other suspect procedures to nicely round out a Top Ten list because who could be bothered with a Top Two? 

Check it out, the Top Ten "Overused Procedures" according to for lack of a byline, Anonymous
1. A C-section with a low-risk first birth

No evidence cited here but I think we can all agree C-sections are major surgeries with not a little risk. Anonymous gets a pass here because there is in fact ample evidence of the risks.  One quibble, why use a chart of the increase in C-sections in the US here? It doesn't really address this claim in particular.  Yes, rates have grown over the last two decades, accounting for a third of births.  Anyhow, it doesn't really get at the risks...minor quibble.

2. An automatic second C-section*

No evidence cited. An expert quote**.  A reference to a 1999 report by the American Congress of Obstetrics and Gynecology.  Yes there is evidence out there but not anywhere in the report.

*Until the last decade or so, vaginal births after a cesarean (VBACs) were not recommended unless basically there was an emergency C-section team assembled in a brightly lit OR. 

**The term "expert" is used in a broad sense.

3. An elective early delivery

A couple studies, an expert and hey why not throw in the chart of early scheduled deliveries in 6 Utah hospitals.
 
Utah.
Six hospitals.
Utah.
Whatever.

4. Inducing labor without a medical reason

One study, couple experts.

5. Ultrasounds after 24 weeks

Evidence of harm? None provided but there's this....

"And the procedure doesn’t provide any additional information leading to better outcomes for either mother or baby, according to a 2009 review of eight trials involving 27,024 women."

A 2009 review.

6. Continuous electronic fetal monitoring 

Evidence?

"....research suggests"

7. Early epidurals

No mention of evidence of risks or benefits (yes benefits).

8. Routinely rupturing the amniotic membranes

"according to a 2009 review of 15 trials involving 5,583 women."

9. Routine episiotomies

"according to a 2009 review involving more than 5,000 women."

That 2009 study is getting its fifteen minutes here.

10. Sending your newborn to the nursery

"Research shows" moms who send their kids to the nursery don't get more sleep.

(i.e. don't even think about the nursery or getting any rest after 9 months of creating another human being let alone the physical assaults of labor and delivery or, don't email me, trying to breastfeed).

Consider this messy report as evidence of what happens when often well-intentioned editors or interns try to distill a diverse body of research into perky lists or simple lessons.  As I've said so often before it's not that it's wrong, it's just not right. Not accompanied by enough nuance.  Some of it, especially the later issues, are not firmly established by studies, especially the last.

As if the above effort was not enough Anonymous and friends have compiled 3 companion pieces that might carry the adverse effect of deterring any further childbearing. This is where it really starts to get decidely less evidence-based.

10 Things You Should Do During Your Pregnancy  

"Listen to yourself"
"Consider a midwife"
"Touch your newborn"  

5 Things to Do Before You Become Pregnant

"Stop bad habits"
"Take control of chronic disease"
"Avoid toxins"

Success Stories  (Cue the music and cute baby nestled against mother's breast)

"Laura Sundstrom was surprised that her expertise as a nurse midwife didn’t fully prepare her for her own pregnancy and childbirth."  Incidentally, a midwife who first has a C-section then followed up with a VBAC. Hardly a surprise, not that this natural-birth proponent had a VBAC but that Consumer Reports featured her success (i.e. not a C-section). 

Emily Timmel, the second successful mom, had a traumatic emergency C-section with her first baby and miraculously, an "amazing" experience with her second child born not surprisingly in a vaginal, natural delivery assisted by a doula and a midwife. 

Those, by the way, were the only sucess stories here. The lesson?  Consider yourself a success if you have a natural, vaginal delivery.  Extra points for success after a C-section.

If only I were pregnant, I could vomit.

Andrea, thanks for the assist. 

As it turns out some of the above advice might not be too awful as you didn't forget to "listen to yourself" (#9). Yes, your inner voice was correct.  Consumer Reports should steer clear of medical studies (and Success Stories) and stick to home appliances, cars and the much-appreciated tortilla chip taste test.
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