Are you familiar with the idea of “evidence-based practice” in medicine? It’s a term those of us in medical professions have had drilled into our heads, and you might be thinking “Isn’t that kind of the point of medicine? That it’s based in the evidence of science?” And to an extent, you’d be correct; we wouldn’t have the millions of advances that led us to our modern western medical model without doctors forming practice around research outcomes and experiments.
But you might be surprised that the phrase “evidence-based practice” only first became a thing in 1992, and with it, a push to make sure we are constantly questioning and revising care to be offering our patients the best options possible. Prior to this – and in some areas of medicine especially – much of practice was based in tradition and believing that because things had always been done a specific way, then that must be the best and only way to do them.
Now if you don’t know me, let me just tell you that this sentiment (which though greatly diminished, still exists in the birth world) really makes my blood boil. If you hear nothing else from what I’m saying take this home with you to ponder: *Just because something is standard practice, does NOT make it best practice.*
In some ways, there are a lot of research gaps in the birth world because it’s difficult and often times unethical to do high quality research and experimental projects with pregnant women – just think, would you want to be randomly selected and told whether you were birthing with or without an epidural with zero regard to what you had envisioned for your birth?
But in many other ways, abundant evidence is available that often shows that many things that US maternity care considers normal, protocol, or standard care for our pregnant patients may not actually be in their best interest, and often times may even be harmful to their birthing process. Seriously.
We have made many great strides in advancing maternal care, but we still have a very long ways to go. There is so much hope and promise for the future of obstetric care, but we can’t give up the fight for our birthing mamas.
For the birthing person, this can get really tricky. It’s often difficult for an untrained person to differentiate between what is actually medically indicated and what steps are options they would be justified in refusing. When non-indicated interventions are presented as the next, best, logical step, a birthing person will often trust the advice of their provider, even when the advice is not based in the current evidence of science and research. I truly believe that providers want to do what is best for mom and baby, but research is hard to keep up with on top of maintaining a busy OB practice. And, unfortunately, I’ve personally witnessed providers maintaining a willful ignorance and refusing to believe a meta-analysis of the data over their anecdotal opinions.
So what is a birthing person to do?
· Know your options! Take a child birth class – a high quality one, usually not the sort that you would sign up for at your local hospital as their curriculum is greatly limited by their facility in most cases.
· Educate yourself using Evidence Based Birth (EBBirth.com) – the brainchild of Rebecca Dekker, a PhD research nurse who is seriously revolutionizing the birth world with her work.
· Hire a doula (or better yet, a TEAM of doulas, *cough, cough*) who is well versed in birth, what is normal, what the current evidence is, and is comfortable helping you know what questions to ask and how to effectively communicate with your birth team.
· Tour other birthing facilities if even just to get a better idea of questions to ask your birth facility.
· Don’t be afraid to ask your provider hard questions. And if their response to those questions sets off any alarm bells in your head, remember your provider works for you – this means that you are well within your rights to demand different options and/or fire your provider to find better care. I’ve never met someone who changed care providers (no matter how close to birth!) and regretted their decision.
I know pregnancy and birth can be overwhelming, but I really challenge you to view this as the beginning of your parenthood adventure – an ongoing process in which you will be making decisions that you feel are best for your family. Just as with a child, I encourage you to use your resources, educate yourself, surround yourself with a support team you trust, and ultimately trust your instincts. Happy birthing, friends!
