2004
DOI: 10.2190/rr53-wq0a-w528-tyce
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The Warp of Evidence-Based Medicine: Lessons from Dutch Maternity Care

Abstract: Most critiques of evidence-based medicine (EBM) focus on the scientific shortcomings of the technique. Social scientists are more likely to criticize EBM for its ideological biases, a criticism that makes sociological sense but is difficult to substantiate. Using evidence from the scientific debate over maternity care in the Netherlands--where nearly one-third of births take place at home--the author shows that research evidence is the product of a researcher's assumptions about the practice in question. In th… Show more

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Cited by 15 publications
(7 citation statements)
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“…Nearly one third of all planned home deliveries end up in hospital [ 66 ]. The ambivalent Dutch maternity care, with its two sciences of obstetrics [ 11 ], might explain the unfulfilled Dutch expectations. In ambivalent social structures, contrary courses of action are simultaneously valued for a single actor in a given situation [ 67 ].…”
Section: Discussionmentioning
confidence: 99%
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“…Nearly one third of all planned home deliveries end up in hospital [ 66 ]. The ambivalent Dutch maternity care, with its two sciences of obstetrics [ 11 ], might explain the unfulfilled Dutch expectations. In ambivalent social structures, contrary courses of action are simultaneously valued for a single actor in a given situation [ 67 ].…”
Section: Discussionmentioning
confidence: 99%
“…The medical status of women having children is not the only relevant information, their social roles and status are also taken into account [ 7 ]. Manifestations of the social model in the Netherlands are the strong independent midwifery profession [ 9 ], the belief in the normality of childbirth [ 9 ], the positive attitude towards home births [ 10 ], and the low obstetric intervention rates [ 11 , 12 ] compared to other European countries. However, this does not mean that the medical model is completely absent from Dutch maternity care.…”
Section: Introductionmentioning
confidence: 99%
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“…Other researchers have described similar clashes between nurse-midwives, who tend to align themselves with modernity and clinical approaches, and the recipients of their care. 22,23 Thus it is important to identify which aspects of professional delivery care can be modified to meet cultural expectations without jeopardising the health of the woman. For instance, in Matlab the nonsupine position or adequate cover of the woman to prevent exposure may increase the acceptability of services by women and their families and community support.…”
Section: Discussionmentioning
confidence: 99%
“…In case of a high-risk pregnancy or complications during birth, the woman is referred to an obstetrician and the birth always takes place in a hospital [1][2][3]. The home birth rate in the Netherlands slightly decreased during the last decade (from 35% to 29%) [4], but it remains uniquely high compared to other industrialised countries [5][6][7]. The literature explains this high home birth rate by the specific combination of social, cultural, political and organisational factors largely in favour of the social model of obstetric care for low-risk pregnant women (opposite to the technocratic model that prevails in other countries) [8][9][10][11][12].…”
Section: Introductionmentioning
confidence: 99%