As we all know, the medical world moves slowly, particularly when it comes to recommendations or guidelines. In many instances when drugs or malignant conditions are being assessed, there is a very good rationale for this slow change and there are many examples to support a thorough and well-reasoned (albeit slow) approach.
Over the last decade there has been a gradual shift away from traditional 'open' vein surgery (the so called 'tie and strip' operation) towards the newer operations that use lasers and other heat-based techniques. These are safer, less invasive, and quicker - patients can leave the hospital on the same day, an hour after the procedure.
Hospitals may prefer to have women - mothers and midwives - under their control. Guess what: women lacking control have more pain during labour and overworked midwives lacking control have more days off sick with stress - and so the cycle goes on - fewer midwives spread ever more thinly until the maternity services are at breaking point and the mortality rates go up.