Evaluating Benefits and Risks of Obstetric Practices--More Coordinated Federal and Private Efforts Needed

HRD-79-85: Published: Sep 24, 1979. Publicly Released: Sep 24, 1979.

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The federal government, through the Department of Health, Education, and Welfare (HEW), has a number of responsibilities relating to obstetric practices, including: (1) ensuring the safety and effectiveness of drugs and medical devices; (2) funding medical research and Professional Standards Review Organizations; (3) educating the public on health care; and (4) paying for deliveries under some federally funded programs. Critics maintain that hazards are associated with the following obstetric practices: (1) elective induction of labor; (2) the use of medication to relieve labor pain; (3) the preventive use of forceps; (4) routine electronic fetal monitoring; and (5) the increasing use of caesarean sections.

HEW has taken some actions regarding obstetric practices, such as the safety and efficacy of some drugs used in obstetrics. HEW recommended that labels of drugs used for induction contain a warning stating that the benefit versus risk ratio for elective induction of labor has not been defined, and the recommendation was also made that two drugs used for induction of labor be removed from the market. Although HEW has a system for collecting information on adverse drug reactions, it has no system for periodically reviewing marketed drugs. HEW has sponsored little research on obstetric practices. Except for evaluations of the use of caesarean sections, Professional Standards Review Organizations have done few medical care evaluations on obstetric practices.

Matter for Congressional Consideration

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Matter: In making a decision concerning whether or how to strengthen the Food and Drug Administration's authority on procedures for regulating drugs, Congress should consider the problems relating to regulation of selected drugs used during labor and delivery.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of HEW should designate the newly created National Center for Health Care Technology, or some other organization, to oversee, coordinate, and promote departmental activities relating to obstetric practices. Specific activities should include: (1) convening a panel of representatives from federal agencies and medical and consumer organizations with interests or responsibilities involving obstetric practices to develop a plan for reviewing obstetric practices; (2) evaluating existing research to give the public an assessment of what is known and unknown about the benefits and risks of various U.S. obstetric practices; (3) setting priorities for and coordinating research efforts of HEW on various obstetric practices and developing a plan to obtain needed data, including long-term effects on the child; (4) determining how to help minimize incorrect use of obstetric procedures through Professional Standards Review Organizations; and (5) emphasizing health education, information, and promotion activities on obstetric practices for health care providers and the public.

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