I am so excited to introduce Rebecca, from Evidence Based Birth. Rebecca will be writing about how to request evidence-based maternity care from your doctor or midwife. Enjoy! -Amy
My name is Rebecca Dekker, PhD, RN, APRN. I am an advanced practice nurse and an Assistant Professor of Nursing at a research-intensive university. I do research on the link between depression and cardiovascular disease. In my spare time I blog about the evidence for birth practices at Evidence Based Birth.
Did you know that many women in the United States (and other countries) receive maternity care that is not based on best evidence?
I was talking with a family medicine physician recently about evidence based medicine and obstetric care. She told me, “To be honest, the obstetricians I work with do not always practice evidence-based care. They talk about ‘standard of care.’ If you ask them why they do an intervention to a woman in labor, they say, ‘Because it’s standard of care.’ Even if the intervention that they are doing has no base in scientific evidence, they still do it because that’s what everyone else is doing, and if they get sued, at least they will be able to say they were doing the standard of care.’”
Standard of care means exactly what it says—this is standard care, or care that is routinely provided by care providers. It’s important for you to understand that standard care is not always evidence-based. In fact, sometimes standard of care has no benefits and can even be harmful (for example, bed rest after your water has broken at term).
On the other hand, evidence-based care means that the intervention (or the lack of an intervention) that is offered is based on best scientific evidence. Evidence based care should always take into account the quality of the evidence—for example, sometimes there is evidence for a certain procedure, but it comes from poor quality research studies. And it’s important for you to understand that evidence-based maternity care should always be woman-centered, meaning that the care that should take into account each woman’s individual cultures and values.
Unfortunately, evidence-based maternity care is hard to come by sometimes. Research has shown that it takes—on average—twenty years for evidence to make its way into clinical practice. This means that it is very possible that you—as a maternity patient—may sometimes receive standard care that is outdated, carries no benefits, and may increase your risk of harm. Now, I’m not saying that all care providers are intentionally providing care that is outdated. One of the reasons that doctors and midwives do not always use evidence-based care is because it is difficult for them to stay up-to-date on the current state of birth science. Sometimes they may not even be aware that there have been changes in the evidence for birth practices. Or, sometimes they may avoid evidence-based care because they are afraid of lawsuits. For example, hospitals may use continuous electronic fetal monitoring because they know the continual recording would be helpful in case of a lawsuit—even though there is strong evidence that continuous electronic fetal monitoring is more harmful for women and babies than intermittent listening with a Doppler.
So what can you, as a pregnant woman, do about this?
My personal belief is that women have to respectfully start requesting evidence-based care from their care providers. But how can you do that, especially if you have no medical or research background? Why would your doctor listen to your advice? That’s where I come in. I have taken my evidence-based articles on various birth practices and turned them into short, printable practice bulletins written especially for your health care providers. Physicians in particular love data and statistics. They want to learn about the evidence that supports (or doesn’t support) the care that they provide.
You can view the free printable practice bulletins here. So far, I have written practice bulletins on IV fluids during labor, having a saline lock during labor, bed rest after your water breaks, water immersion during labor and birth, eating and drinking during labor, and Pitocin augmentation. “Like” my page on Facebook to find out about future bulletins as I publish them!
So how can you use these printable practice bulletins? If you find that your doctor or midwife does not support one of your birth preferences, print the relevant bulletin off and bring it to your next appointment. Respectfully ask if they’ve heard about this research evidence, and ask them to read it when they get a chance. Use this as a starting point to discuss the evidence surrounding certain aspects of your care. Not sure how to go about saying this? You might say something like, “I’ve heard that the hospital I’m giving birth at doesn’t allow eating and drinking during labor. However, I’m really interested in eating and drinking during labor so that I can keep my hydration and energy levels up without IV fluids. I was wondering if you’ve seen this evidence. Would you mind looking at it so that I can get your thoughts on this?” The key is to stay respectful and diplomatic during your conversation.
Don’t be afraid to share this evidence. You might be pleasantly surprised by your care provider’s reaction! It’s possible your care provider will admire your interest and investment in your own care, and that he or she may learn something new from reading the practice bulletin.
How else can you use these practice bulletins? If you are giving birth in a hospital (as 99% of American women do), print the bulletins off and keep them in your hospital bag. They may come in handy when interventions are offered to you—both for your own reference and for your care provider’s.
I love these practice bulletins and think that they offer a concrete tool for women and their families to use to educate both themselves and their birth care providers. Hop on over to Evidence Based Birth to check out more of Rebecca’s great work. Thank you Rebecca!