Ob-Gyns Do Too Much Fetal Monitoring
[Scientific American, 2/7/19] It’s important in high-risk pregnancies, but most pregnancies aren’t risky.
For nearly three decades, I reminded every woman I saw in my family practice, from adolescence onward, to do a monthly self-breast examination (SBE). It made great sense in theory: the earlier you find a malignancy, the earlier you can treat it, and the better the outcome.
But when researchers looked at actual outcomes, they found that women who discover lumps when doing a routine self-exam live no longer or better than women whose tumor is found with an exam by a health care provider; a mammogram; or accidentally, by the woman herself or a lover. The one difference between the two groups was that the women who found lumps with a self-exam had more procedures, expenses and worry.
Based on solid evidence, the American Cancer Society recommended in 2003 that self-breast examination be optional for women over the age of 20. By 2015, ACS guidelines for women at normal risk (e.g., with no family history of breast cancer) didn’t even mention the SBE, nor even clinician exams. Mammograms, starting from the age 40 or 45, became the sole focus for screening low-risk populations. Of course, any woman who does find a breast lump (or man, for that matter) should see a provider right away.
Continuous fetal monitoring (CFM) is another of those widespread measures that makes much better logical than clinical sense. In the 1880s, midwives learned to assess the well-being of a fetus by counting the baby’s heartbeats, audible through a stethoscope applied to the mother’s abdominal wall. The modern cesarean section was added to the surgical armamentarium at about that time, providing a powerful option for managing fetal distress. Doctors could literally snatch compromised babies right out of their mothers’ wombs………….
Read the Full Article at: Scientific American
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Jaelin Stickels, CNM, WHNP