Obstetrics Myths

Pregnancy and Childbirth Myths

Ultrasounds

3rd trimester ultrasounds are routine. FALSE. Low risk pregnancies constitute most of the pregnancy population and there is no evidence at present that conclusively demonstrates an additional scan at 32, 34 or 36 weeks improves maternal and neonatal outcomes and is cost effective.

The accuracy of a routine 3rd trimester ultrasound in determining the baby’s weight IS AT BEST 70-80%. There is therefore the potential for harm, anxiety, and additional health care costs through unnecessary intervention due to false positive results.

The practice is common in Wollongong and often reflects where an obstetrician trained. Over 50% of local GPs still erroneously believe this is standard practice.

I have letters (2016-2017) from the Area Health Service confirming routine 34-week ultrasounds are not standard practice, so if you’ve had a “routine 3rd trimester ultrasound” in the public hospital system in the past 6-7 years and want a copy of the letters, please get in touch. Feel free to make a complaint to the Area Health Service or NSW Minister for Health. It’s your time, money or taxpayer dollar being wasted.

Ultrasound
Ultrasound-Illawarra-Womens

Aspirin

Aspirin should be used liberally to prevent high blood pressure. FALSE. The only proven benefit for the use of Aspirin in pregnancy is when there is a history of:

1. Early (less than 37 weeks) Preeclampsia
2. Antiphospholipid Syndrome

The Aspirin works best if taken at night – we don’t yet know why. My view, in the absence of clear evidence of benefit, don’t take it.

CTGs

The CardioTocoGraph (CTG) – is used to monitor a baby’s heart rate and uterine contractions and traced out on a graph).

Surprising fact: The CTG has never been scientifically validated. A normal trace is reassuring but its only as good as when it’s on. When used unnecessarily it increases the chance of a caesarean section without reducing the chance of fetal death. It has had no impact on reducing the rate of cerebral palsy.

Not once in 8 years have I sent a patient for serial CTGs (2-3 times weekly). It’s an unnecessary waste of your time. When I questioned this practice years ago in Wollongong Public Hospital, I was informed by a senior obstetrician that “It makes them feel like we care and are doing something”. Personally, it’s just another sign of a broken system, lazy or poor clinical judgment, slavishly following guidelines, and driven by a fear of litigation. Lawyers love CTGs.

Birth

1. Twins must be delivered by caesarean section. FALSE. There is no trial that confirms that caesarean section is safer than normal vaginal delivery. There are however certain factors that could warrant a caesarean delivery e.g., presenting twin is breech and the following twin is head down – the heads can lock.

2. Breech babies must be delivered by caesarean section. FALSE. Anyone with at least 1 prior normal vaginal delivery is potentially a good candidate for a breech delivery. There are however certain factors that could warrant a recommendation for caesarean delivery.

3. Physiotherapists have special training allowing them to decide on whether a woman should attempt a Normal Vaginal Delivery (NVD) or should have a caesarean section. FALSE.

In the past, obstetricians have attempted to work out early in a pregnancy or before a subsequent pregnancy whether it’s safe to attempt a NVD because of the size of the maternal pelvis. This was based on a vaginal examination, X-ray, or CT pelvimetry or a combination of these approaches. There was (and is) no clinical evidence for any of these methods. I’m not sure why some physiotherapists are now claiming special insight or skill in making suggestions about route of delivery. That’s a decision for the mother-to-be and her obstetrician.

4. If the Estimated Fetal Weight (EFW) is on or above the 90th centile caesarean should be offered or recommended. FALSE.

There is no clinical evidence for this practice or recommendation whatsoever. The average obstetric growth centile depends on the specific population and the gestational age at which the measurements are taken. In general, a baby with a growth centile between the 10th and 90th percentile should be considered to have average growth.

A growth centile above the 90th percentile MAY indicate large-for-gestational-age (LGA) growth. It may also simply reflect a genetically large baby with appropriate growth. Recall that third trimester ultrasounds are at best 70-80% accurate for weight estimation.

Shoulder dystocia (where the head delivers and the shoulders get stuck) is rare and cannot be reliably predicted e.g., it can happen with larger mothers-to-be with (presumably easier to deliver) small babies.

5. Older mothers should be advised to have a caesarean section. FALSE. Age is not a direct indicator for a caesarean section. Other age-related factors that may increase the likelihood of certain complications could potentially lead to a caesarean delivery e.g., coronary artery disease. Care should always be tailored to the individual.

6. Mothers conceiving by IVF should be advised to have a caesarean section. FALSE. IVF is not a direct indicator for a caesarean section. Certain infertility factors may increase the likelihood of complications that could potentially lead to a caesarean delivery e.g., serious uterine anatomical anomaly.

7. Having genital herpes (HSV) automatically means a caesarean section. FALSE. There may be some advantage for a caesarean section if, and only if, it’s the very first outbreak ever and occurs just prior to the onset of labour. A recurrence does not carry the same risks to a baby as a primary outbreak.

8. You can’t have a Vaginal Birth After a Caesarean (VBAC). FALSE. VBAC is possible and encouraged if certain selection criteria are met. This depends on the reason for the original caesarean and other risk factors such as the presence of diabetes, high blood pressure etc.

9. You can’t have a Vaginal Birth After 2 Caesareans (VBA2C). FALSE. There is no increased risk over and above those for a vaginal birth after 1 caesarean section if there are no other risk factors as for VBAC.

Epidurals

Epidurals cause long-term back pain. FALSE.

There is no clear-cut evidence for this assertion. Research on this topic has produced mixed findings, with some studies suggesting a potential association between epidurals and long-term back pain, while others have found no significant link. Back pain is common regardless of whether someone’s had an epidural.

Contraception

You can’t get pregnant while breastfeeding. FALSE.

You can ovulate as early as three weeks after having a baby and fall pregnant again.

Total Pregnancy Care

We understand that while thinking about your precious baby is exciting, it can also be stressful, and with all the information available, a little overwhelming. We welcome questions. The more, the better. We are conveniently based in the Wollongong CBD and are here to ensure you have the best information for your circumstances and needs.

Total Pregnancy Care

We understand that while thinking about your precious baby is exciting. It can also be stressful, and with all the information available, a little overwhelming. We welcome questions. The more, the better. We want you to have the best information for your circumstances and needs.

Google Rating
5.0
Based on 146 reviews
×
js_loader