Have you ever felt that some of the restrictions that were in place during the birth of your child did not work in your favor? Did you ever wonder if they had truly been essential? Was that caesarian section medically necessary or planned to fit someone else’s schedule? Are you currently pregnant and uneasy about being told you have limited options because of policies already in place that don’t have clear evidence to support them? If so, read on.
LOOKING FOR EVIDENCE
Many birthing women are now taking a greater role in researching, making decisions, and managing their care options. Rather than simply taking their care provider’s word for it, pregnant women are insisting on scientific proof to back up claims that an intervention or procedure is truly necessary.
Organizations that advocate for pregnant women and individuals who are taking more responsibility for their maternity care are actively seeking to identify hospitals and care givers who utilize an evidence-based model.
As more comes to light about how standard maternity care in many places in the US (and internationally) is not always supported by the evidence from best outcomes, consumers are pushing for answers and demanding change.
ARE FEWER BABIES REALLY BORN ON WEEKENDS?
Still unclear about what this is all about? Here is a great example. On which days of the week are babies born in US hospitals? You might think that babies don’t much care what day it is: they come when they are ready. However, doctors at hospitals do. Have a look.
Is it simple coincidence that all those necessary cesarean births seem to plummet on the weekends or is there something else at work here?
WHERE TO FIND THE EVIDENCE
Answers are not always easy to come by but there are places to go for help. Here is a round-up of several resources available to a mother looking for evidence that the care she is being given has been proven through research to be the best way forward for her and her child.
Although the philosophy of Evidence Based Medicine (EBM) has roots that go way back in history, the modern movement for the current discussion around the topic can be bookmarked to this piece published in the British Medical Journal (BMJ) in 1996 and authored by David L Sackett, William M C Rosenberg, J A Muir Gray, R Brian Haynes, and W Scott Richardson.
As the realization that many medical policies and care plans were not necessarily based on current best evidence, a movement began to better synthesize and take into account the evidence for or against interventions and treatments in all areas of medicine. An interesting oral history of the EBM movement discusses how people have traditionally been influenced more by the perception of authority than by evidence and why it is important to know the difference. One of the participants, Kay Dickersin, Director of the Johns Hopkins Center for Clinical Trials and Director of the US Cochrane Center says “It is curious, even shocking that the adjective ‘evidence based’ is needed. The public must wonder what basis medical decisions are made otherwise. Is it intuition? Magic?”
The Cochrane Collaboration is the gold standard in EBM. It is a 20-year-old, international, non-profit network of researchers, patient advocates, practitioners and others who have come together to provide access to systematic reviews of the available medical research evidence worldwide. Summaries of resarch are available to anyone in the US at their website. It is easy to find a good deal of information regarding common maternity care practices using this resource.
THE ADVOCACY GROUPS
Pregnant women and their families can often be overwhelmed when faced with some of the various tests or suggested procedures that are offered or recommended to them prenatally or while laboring. Several advocacy organizations have been at the forefront of helping pregnant women access evidence based information and care. A starter list of individuals and organizations who are helping to support this quest include:
Childbirth Connection highlights the Milbank Report, which identifies barriers to providing evidence-based maternity care and gives suggestions on how to overcome those barriers.
Lamaze International, the premier childbirth education association, offers Sense and Sensibility, a research blog about pregnancy and birth.
Our Bodies, Ourselves is a health resource center with pregnancy and birth coverage.
Improving Birth offers articles, research links and social action around EMB.
One of the best resources out there for pregnant women and advocates is Evidence Based Birth, an organization started by Rebecca Dekker.
Being a researcher and a nurse herself, Rebecca set to work investigating if some of the recommendations that she took for granted during the birth of her daughter were based on clear evidence. It turns out that the evidence was scant for some of the policies and procedures that she had assumed were necessary. That realization prompted her to do things differently with her second child.
Rebecca used her experience, skills and research and took big action! Her website, Evidence Based Birth, is a virtual treasure trove of birth related research, distilled down into information that the non-researcher can easily understand and utilize.
This site offers a long list of articles in Q & A blog format, printable documents, video-based online classes that include continuing education credits and a newsletter. Subjects are well organized and can be accessed using an alphabetized topic list.
US MATERNITY CARE: NOT AS GOOD AS WE BELIEVE
With less than stellar maternal and infant mortality rates here in the US, there is much discussion in the birth world about finding ways to improve these results. Promoting and utilizing an evidence based medicine model makes it easier for all of us to get a clearer picture of what are the best care options for a woman based on her own unique pregnancy and labor.
Maureen Whitman is an experienced childbirth educator, breastfeeding counselor and postpartum group facilitator who is working to expand the conversation about birth and related issues to the audience of young adults who are not yet pregnant. She is the founder of birthphilosophy.com, a forum that features a mix of young and veteran voices engaged in exploration and discussion of the culture and politics of birth in the US and internationally.