Midwives would prefer a vaginal delivery

Abstract

They should be seen because they are a good resourceEditor-The role of drug company representatives is changing, but Griffith's advice not to see them would deprive general practitioners of a good resource, which would be costly to replace.1 They offer many useful services that may not be easily accessible from other sources in the wider NHS, including up to date information on products and the provision of papers relating to a particular product or disease.As primary care groups develop, this contact with individual doctors is likely to diminish, but the representatives' role in helping with the development of a formulary in each primary care group could be vital. Their ability to supply up to date information about particular products is also of great benefit to hospital pharmacists in NHS hospital trusts, who are often responsible for maintaining the hospital formulary under the guidance of the drug and therapeutics committee.Pharmaceutical representatives are frequently a vital financial resource in the provision of sponsorship for meetings as part of continuing professional development.Indeed, half of general practitioners' postgraduate education is sponsored by the pharmaceutical industry, and much of that sponsorship is initiated by the representatives. The standard of continuing professional development is unlikely to be maintained without that sponsorship. Griffith suggests that doctors feel obliged to see representatives and that junior doctors need education on the pitfalls of doing so. There is no evidence for these statements. Indeed, younger doctors frequently have better skills in critical appraisal and are thus more likely to question the representative hard. If he or she does not have evidence based knowledge of the product then younger doctors are unlikely to use it. Doctors could, though, usefully be given education about the Association of the British Pharmaceutical Industry's code of practice, which spells out what doctors may and may not expect from representatives as well as the penalties for doctors who try to induce representatives to break the code.Pharmaceutical representatives are well trained and obliged to pass an examination within two years of beginning work. They can be a valuable resource in the provision of information and papers. Rather than stop seeing representatives as Griffith advocates, doctors should turn the representatives' visit into a positive occasion, ask questions, demand information, and make use of them. Richard Tiner medical directorAssociation of the British Pharmaceutical Industry, London SW1A 2DY JJack@abpi.org.uk 1 Griffith D. Reasons for not seeing drug representatives.

Prevalence and Persistence of Health Problems After Childbirth: Associations with Parity and Method of Birth

“…In the United Kingdom a survey of female obstetricians reported that 31 percent would choose an elective cesarean in an uncomplicated pregnancy to avoid future pelvic floor problems (67). In a similar survey among midwives, only 4 percent said they would choose an elective cesarean (68). Since incontinence may not increase substantially until many years after childbirth (69), studies with long follow‐up are needed to properly evaluate the association between cesarean delivery and preservation of urinary continence and other problems associated with pelvic floor integrity.…”

Non-pregnant patients? preference for delivery route

“…Regarding their personal preference for delivery or how they would advise family members, 1.4% of Dutch obstetricians and 9% of Israeli obstetricians elected cesarean, whereas 31% of female obstetricians in London chose abdominal delivery, mainly to prevent perineal damage [25,26,27]. Of midwives surveyed in England, 5% selected cesarean for uncomplicated singleton birth [28]. Among Israeli obstetricians surveyed, 45% supported elective cesarean [25].…”

Women's Preference for a Cesarean Section: Incidence and Associated Factors

“…They aimed to determine women's role in the decision to have a cesarean section with specific emphasis on women requesting, demanding, or choosing it. Other studies that examined women's preferred type of birth involved specific subgroups of women, such as London obstetricians (13), British midwives (14), Dutch obstetricians (15), and women with a history of previous cesarean section (16–20), and focused on preference for a cesarean section only. Few studies have compared the general population of birthing women who want a cesarean section with those who prefer other types of birth.…”