Ben Goldacre – author of Bad Science, scourge of secretive Pharma companies, and champion of evidence-based healthcare – highlighted a great resource on his secondary blog. It is a collection of ‘do not do’ recommendations from the National Institute for Health and Clinical Excellence (pleasingly abbreviated to NICE), which publishes guidelines on best healthcare practices within the UK’s National Health Service.
The ‘do not do’ database holds information on a range of clinical practices that NICE recommend should be stopped or not used routinely, all of which is based on the best available evidence. There is a section on ‘Gynaecology, Pregnancy and Birth’, which contains 174 recommendations. Many are for specific interventions that may be more of interest to health professionals, such as “A serum ferritin test should not routinely be carried out on women with heavy menstrual bleeding (HMB)”. But there are a few nuggets that mothers- and fathers-to-be may like to hear.
There is a range of advice on alternative and complementary therapies, for instance: “Healthcare professionals should inform women that the available evidence does not support herbal supplements, acupuncture, homeopathy, castor oil, for induction of labour”. There is no evidence for hot baths, enemas or sexual intercourse either. For labour pain, “transcutaneous electrical nerve stimulation (TENS) should not be offered to women in established labour”, which our midwife obviously had not read (or just ignored!).
As for acupuncture, acupressure and hypnosis, they “should not be provided, but women who wish to use these techniques should not be prevented from doing so”, which seems sensible, although potential side effects should be forgotten. Generally for alt med, it advises that: “Pregnant women should be informed that few complementary therapies have been established as being safe and effective during pregnancy. Women should not assume that such therapies are safe and they should be used as little as possible during pregnancy.” Sound advice.
There is a mention of supplements during pregnancy – iron supplements shouldn’t be taken routinely (unless a deficiency is identified) – but I would love to see that section expanded to cover other areas of nutrition. More specifically, there is no good evidence that magnesium, folic acid, antioxidants (vitamins C and E), garlic, fish oils or algal oils can help prevent disorders related to high blood pressure, such as pre-eclampsia.
A random titbit that’s not really connected with other recommendations, says that if a women wants to breastfeed, then breast examination during pregnancy does not seem to help breastfeeding in the long run.
There are more pieces of intriguing guidance about midwife support during labour (“Team midwifery and active management of labour), psychosocial interventions to reduce the likelihood of developing a mental disorder, and approaches to fertility problems.
All of which can only be good for mums and dads in making informed decisions and for health professionals in providing the best care possible. Happy browsing!