Revisiting "the maximin strategy in modern obstetrics"

Howard Brody, Carol Sakala

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Published in 1981, The Maximin Strategy in Modern Obstetrics" offered two claims-first, that obstetrical interventions ought to be assessed not singly, but rather as packages of interconnected measures that could cumulatively increase risks of harm; and second, that many of these interventions, considered either singly or as a package, lacked a sound evidence base. The first claim has been well supported by later literature, although the term "cascade effect" has proven a more felicitous descriptor for the phenomenon of interventions that trigger the use of other interventions to monitor, prevent, or treat possible side-effects. The second claim was initially supported in a very inadequate way, since the "Maximin" article appeared before an understanding of the methods of systematic reviews of medical evidence had been widely promulgated. Despite these defects, subsequent, rigorously conducted systematic reviews have tended to confirm the impression first offered in 1981, that practices that support physiologic childbearing and the innate, hormonally driven capacities of childbearing women and their fetuses/newborns are much more in keeping with the available evidence than practices involving common or routine high-technology interference with physiologic processes. Harm may occur either directly, through high-technology interventions, or when such procedures distract attention and resources from safe, effective biological processes and lower-technology measures. Surveys indicate a lack of knowledge of this evidence among childbearing women, signaling a serious ethical deficiency in shared decision-making processes and perhaps the skills and knowledge of maternity care clinicians.

Original languageEnglish (US)
Pages (from-to)198-206
Number of pages9
JournalJournal of Clinical Ethics
Volume24
Issue number3
StatePublished - Sep 2013

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obstetrics
Obstetrics
Technology
high technology
Biological Phenomena
evidence
Decision Making
Fetus
Newborn Infant
decision-making process
interference
lack
resources

ASJC Scopus subject areas

  • Health Policy
  • Issues, ethics and legal aspects
  • Health(social science)

Cite this

Revisiting "the maximin strategy in modern obstetrics". / Brody, Howard; Sakala, Carol.

In: Journal of Clinical Ethics, Vol. 24, No. 3, 09.2013, p. 198-206.

Research output: Contribution to journalArticle

Brody, H & Sakala, C 2013, 'Revisiting "the maximin strategy in modern obstetrics"', Journal of Clinical Ethics, vol. 24, no. 3, pp. 198-206.
Brody, Howard ; Sakala, Carol. / Revisiting "the maximin strategy in modern obstetrics". In: Journal of Clinical Ethics. 2013 ; Vol. 24, No. 3. pp. 198-206.
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