COMMENTARY ON: Wassen MMLH, Zuijlen J, Roumen FJME, Smits LJM, Marcus MA, Nijhuis JG. Early vs late epidural analgesia and the risk of instrumental delivery in nulliparous women. BJOG 2011;118:655–661.
IN THE LITERATURE
The Tyranny of Meta-analysis and the Misuse of Randomized Controlled Trials in Maternity Care
Article first published online: 28 FEB 2012
© 2012, Copyright the Author. Journal compilation © 2012, Wiley Periodicals, Inc.
Volume 39, Issue 1, pages 80–82, March 2012
How to Cite
Klein, M. C. (2012), The Tyranny of Meta-analysis and the Misuse of Randomized Controlled Trials in Maternity Care. Birth, 39: 80–82. doi: 10.1111/j.1523-536X.2011.00522.x
- Issue published online: 28 FEB 2012
- Article first published online: 28 FEB 2012
- epidural analgesia;
- home birth;
- randomized controlled trials
Abstract: Recent meta-analyses of key areas in maternity care have covered home birth and epidural analgesia. In each of these cases serious issues have arisen from the use of subjective inclusion and exclusion criteria, heterogeneity of included studies, and inclusion of studies that were conducted in settings that were not representative of usual maternity care. This latter flaw is especially notable for early epidural analgesia, where study environments with very low cesarean section rates are included. Such study settings lack external validity and have raised concerns about the political uses of meta-analysis. For a meta-analysis to be useful, the included studies must be broadly representative of the way that maternity care is carried out in usual birth environments. (BIRTH 39:1 March 2012)