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The Tyranny of Meta‐analysis and the Misuse of Randomized Controlled Trials in Maternity Care
Author(s) -
Klein Michael C.
Publication year - 2012
Publication title -
birth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.233
H-Index - 83
eISSN - 1523-536X
pISSN - 0730-7659
DOI - 10.1111/j.1523-536x.2011.00522.x
Subject(s) - maternity care , meta analysis , inclusion (mineral) , inclusion and exclusion criteria , randomized controlled trial , medicine , nursing , psychology , alternative medicine , health care , economics , economic growth , surgery , social psychology , pathology
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)