While many doctors and midwives still recommend the book, others tell patients to throw away their copies or simply to read them with skepticism. She prefers newer guides that generate less worry. The American College of Obstetricians and Gynecologists, which publishes a competing guide for mothers-to-be, declined to comment officially on "What to Expect.
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Jordan Horowitz, a member of the college and an associate clinical professor at the University of California, San Francisco, medical school, said that while the book's information is valid overall, "certain areas go a bit too far" and fail to distinguish between hypothetical concerns and urgent ones. Alexander Anthopoulos, an obstetrician in the Philadelphia suburbs, said, "There are so many warnings and admonishments that patients become frightened of normal symptoms. He and other doctors also say that although the book offers generally sound advice, there are a few notable exceptions: for example, the warning that performing oral sex on a pregnant woman can create an embolism that could kill both mother and fetus.
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Anthopoulos said. Or consider the case of the killer hiccups. Late in the pregnancy of Stephanie Goldsborough, one of Dr. Horowitz's patients, her stomach began to pulse with rhythmic little jerks. She referred to her copy of "What to Expect," which cautioned that a baby's hiccups could indicate a knotted or tangled umbilical cord. Panic-stricken, she and her husband visited their doctor, who gently reminded the couple that hiccups are generally not life-threatening.
Heidi Murkoff, one of the original authors of "What to Expect" and now chief custodian of the franchise, acknowledged that the hiccup warning -- which she recently removed in response to reader complaints -- "was a mistake. Murkoff added. She, her mother and sister, wrote the book in the early 's to reassure women who felt caught between obstetricians, who "hadn't gotten the memo yet that they weren't God," Ms.
Murkoff said, and natural-childbirth types who frowned on epidurals, let alone Caesarean sections.
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The first edition was relatively light on disaster scenarios, but as the popularity of "What to Expect" grew, Ms. This manual describes the methods and processes used for developing standard clinical guidelines. This service guidance is developed primarily for service commissioners rather than healthcare professionals, and focuses on the broad configuration and provision of clinical services. It addresses only interventions that are likely to have implications for the configuration of services for example, the Cancer service guidance series. NICE also agreed in , as part of its programme of work to support the NHS quality and productivity agenda, to look increasingly for opportunities to make recommendations on service delivery within clinical guidelines.
Broadly, these recommendations will fall into the following categories:. The development process for NICE service guidance is largely the same as that for clinical guidelines. NICE's Guidance Executive approves 'signs off' the final guideline and confirms that the correct process has been followed for its development. Prepares the workplan [ a ]. Advises NICE on issues concerning publication, dissemination, implementation and updating of the guideline.
Responds to comments received during consultation and agrees on necessary changes to the guideline. Identifies and approaches potential patient and carer stakeholder organisations for each clinical guideline.
Encourages and facilitates applications from patients and carers who are interested in becoming GDG members. Attend the stakeholder scoping workshop to discuss the scope of the guideline and the recruitment of GDG members. Contribute to developing the implementation tools and may become involved in implementation activities.
More information about key groups and individuals involved in clinical guideline development is given in appendix N and on the NICE website.
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The key stages in the development of NICE clinical guidelines are summarised in figure 1. The full guideline contains all the background details and evidence for the guideline, as well as the recommendations. The NICE guideline contains only the recommendations from the full guideline, without the information on methods and evidence. The NICE pathway is a practical online resource for healthcare and other professionals that contains all the recommendations from a guideline, as well as any other NICE guidance that is directly relevant to the topic.
It also contains links to implementation tools and to related NICE guidance and pathways. In addition to the different versions of the guideline, NICE also produces tools and may undertake a range of activities to support implementation.
All versions of each clinical guideline, and the associated implementation tools, are published on the NICE website. As it becomes available, the following information about each clinical guideline can be found on the NICE website:. We welcome comments on the content of this manual and suggested subjects for inclusion. Kimberly Harney, a clinical assistant professor of obstetrics and gynecology at Stanford Medical School. Aware of the criticism, Ms. Murkoff retired the Best Odds name with the third edition of "What to Expect" three years ago, but a practical problem remained. Even those women with extraodinary powers of discipline, let alone the hormone-addled, morning-sick majority, could hardly follow the program, which involved regular doses of flaxseed and deemed bran muffins an indulgence.
Murkoff said of what she calls the "whole wheatier than thou" approach. But old "What to Expect" volumes never seem to die.
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Even though Ms. Murkoff adjusts them with each printing, meaning every four to six weeks, the books have become so totemic that they are passed on and on. As a result miscalculations like the hiccups fallacy and phrases like the Best Odds Diet endure. The book still makes much of its just-us-gals origins.
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Murkoff has no medical training and said she asks obstetricians to comment on manuscripts only late in the process. The woman-to-woman tone and the folksy-looking pastel jacket may fool prospective readers into thinking they will receive warm affirmations. But the peer-to-peer approach can feel "way more doctrinaire and oppressive than any expert ever would have presumed to be," said Ann Hulbert, the author of "Raising America: Experts, Parents and a Century of Advice About Children.
Hulbert agreed -- especially those who pore furtively over the book in the giddy days that follow a positive home test -- haven't been toughened by the shoulds and shouldn'ts parents constantly face. It may be that "What to Expect" is suffering from its own success, a casualty of the revolution it helped foster. Laura Brenden, a Manhattan mother-to-be, started the book "thinking it was the end-all, be-all," she said, so she was especially disappointed to find it depressing and "alarmist to the nth degree. Its intention was to teach women about pregnancy, but many women are now so hypereducated that they can issue devastating critiques of whatever missteps they perceive the authors made.