Two-Thirds of US Obstetric Guidelines are Based on Weak Evidence and Bias

The September 2011 issue of Obstetrics and Gynecology, the official publication of the American College of Obstetricians and Gynecologists (ACOG), reported that only 1/3 of all of the AGOG guidelines – which form the basis of practice of obstetrics in the US – are based on scientifically sound evidence. The authors of “Scientific Evidence Underlying the American College of Obstetricians and Gynecologists ‘Practice Bulletins'” state 1/3 are based on limited or inconsistent evidence, and the remaining 1/3 are based on expert opinion, which, according to the article is “subject to bias, either implicit or subconscious.” When compared to guidelines from the Royal College of Obstetricians and Gynaecologists, 28% of obstetric recommendations were the same, 56% were not comparable, and 16% were opposite! This is an important report because ACOG guidelines almost entirely determine how labor and birth are managed in the hospital, and influence the cultural and medico legal attitudes of fear surrounding childbirth – and the resultant astronomical levels of intervention in birth. If 60% of ACOG guidelines are based on weak evidence and bias, then what percent of the 40% national average for cesareans are also based on weak evidence and anti-birth bias?