The maximin strategy in modern obstetrics

Abstract

Many currently accepted obstetrical practices exemplify a maximin strategy: making the best of the worst possible outcome, regardless of the actual probability of that outcome occurring. But a survey of recent obstetrical research fails to document superior clinical results when this strategy is employed in routine obstetrical care. Most research has studied obstetrical technologies in isolation rather than as parts of systems of interconnected interventions: this approach has tended to underestimate the risks of intervention and to overestimate the utility of a maximin strategy. Physicians practicing obstetrics should adopt a flexible approach and match the degree and type of intervention to actual patient needs. Better methods of assessing preventable prenatal risk are needed to allow identification of the rare-obstetrical patient requiring maximal intervention.