My previous post was long enough without addressing another serious deficiency in these guidelines. It is worth its own post.

The guidelines are written by doctors. And only doctors (actually only Obstetricians). There is no input mentioned from any other stakeholders.

Most importantly no parents.

Surely the time has come to stop doing this, to stop physicians gathering in closed rooms and deciding what is best for the rest of the population. This is not a new idea, it has been strongly recommended for many years. The Institute of Medicine published guidance 4 years ago (to my mind their guidance leaves the patient/parent out of the process until too late) about involving patients/parents in the guideline development process. There are very high profile editorials in leading journals. There are even blog posts about it!

So why are bodies like ACOG and the SMFM not doing this? Is it because they may not like what they would hear? Is it easier to meet around a table with other physicians and not be challenged by a patient? Is it even easier if you limit the physicians to just your Obstetrical colleagues?

One of the reasons identified for why clinical practice guidelines have little effect on practice is the lack of involvement of the people most affected by them.

Because that is the whole point. The Obstetrician will leave work at the end of the day to go home, the families are marked forever by these decisions. Whichever way they go.