What is Evidence Based Birth and Why Should I Care?

By Rebecca Dekker, PhD, RN, APRN from www.evidencebasedbirth.com

 

Have you ever been told that you have to do things a certain way when you are giving birth? That your care provider may or may not allow you to do something?

As a nursing professor, I teach my students to always ask the question, “Why? Why do we do things a certain way? Is there any evidence to back this up?”

So today I am going to talk with you about how it’s okay—and it’s even best—if you ask “What’s the evidence for that?” when you are told you need to do things a certain way during pregnancy and birth.

When I got pregnant for the first time, even though I was a nurse, I really didn’t know that much about labor and delivery. I read a few baby books, took the brief hospital class, and looked through my old OB textbook a couple of times. I thought that was all I needed to know—because my care providers would guide me through labor and delivery, and they knew what was best, right?

I ended up having a pretty typical labor and delivery in the hospital—a vaginal birth of a 6 pound 8 ounce little girl– along with IV fluids, continuous monitoring, strict bed rest, nothing to eat or drink for 24 hours, Pitocin and an un-wanted epidural for “failure to progress,” vacuum extraction, and finally—immediate separation from my healthy baby after birth so that she could be observed in the nursery for several hours.

A few years later, when I became pregnant again, I started thinking about everything that I had experienced in the hospital. By this time, I had finished my research doctorate and I was in a full-time nurse faculty position, teaching nursing students and doing research. As a teacher, I was talking every day with my students about evidence-based practice. Meanwhile, as a researcher, I was discovering new evidence for how to best take care of people with heart disease.

Then one day, I started to get curious. I had always had a gut feeling that there was something wrong about my first birth. I was a completely healthy, low-risk pregnant woman who was in great physical condition. I was as healthy and strong at 9 months pregnant as I am right now. So why did I get the feeling that something was wrong about the care I received? Was my care really based on best evidence?

For those of you who don’t know, evidence based care means that your healthcare is based on the most up-to-date medical evidence about what works best. Evidence-based care also means that you are informed accurately about risks and benefits of different options, so that you can make the best informed medical choices for your unique situation.

Using the resources at my university, I began to read the medical evidence for the care I received at my first birth. Imagine my surprise when I learned that much of the care that I received has been shown by medical evidence to be harmful to healthy pregnant women and their babies!

Amazed by the evidence I was uncovering, I googled “evidence-based care during labor and delivery.” I was stunned to find that nobody else was really blogging about this the way I thought it could be done. The evidence exists out there—but in order to read the evidence you need an expensive subscription and you need to have research skills in order to decipher the evidence. I happened to have both the subscription and the skills. I thought to myself, “Wouldn’t it be great if I could blog about the evidence about birth options so that pregnant women all over the world can access and understand this information?”

And so www.EvidenceBasedBirth.com was born!

At Evidence Based Birth, my main goal is to write articles that review the highest quality medical evidence for certain birth practices. For examples of evidence-based articles, click here. For your sake, I always have at least two experts review my articles, and I try to write the articles in as non-biased a way as possible. I don’t want to insert my personal opinions into these articles. Instead, I would like for the evidence to speak for itself, and then let you and your care provider decide how you want to use that evidence for your unique situation.

I realize that educating people about the evidence is not enough. Real-life stories can give people the courage to put evidence into motion. So I publish testimonials, written by women and care providers, that promote the use of evidence-based practice. For examples of testimonials, click here.

Another resource for you at Evidence Based Birth are printable practice bulletins. These are 1-2 page, printable versions of my articles that are written in the language of healthcare providers. You can print these off and use them to start discussions with your care provider about evidence based care. To see a list of available printable practice bulletins, click here.

 

Why should I care about whether or not my birth is evidence-based?

Nursing students are in a unique position to observe what is going on in the maternity care system with a fresh, unbiased view. I asked a nursing student who is currently in her OB clinical rotation to share her impression about why you should care about evidence-based birth:

Kara Lester, a BSN nursing student, writes:

“As a nursing student currently in my OB rotation, I have met many pregnant mothers throughout the semester. Some are well-educated, while others have more limited knowledge about pregnancy. It is so important for women to be active participants in their care because it gives them autonomy within the healthcare setting. Women who are aware of the evidence and options available will have more confidence when it comes to voicing their thoughts and feelings to healthcare providers.

“Also as healthcare providers, we need to empower women to get more involved in their care by giving them the facts and letting them decide what option is best for their situation. During one of my clinical rotations, I sat through a birthing class with a first-time pregnant couple and saw firsthand that as their knowledge grew, so did their confidence. As the couple became more engaged, they started to feel more comfortable in their decisions. It was really neat to see their transformation from being quiet and anxious to calm and confident. Witnessing this reminded me that as an active participant you really can have an influence on the care you receive—and ultimately the outcome of your stay.”

 

What can I do next?

You have already taken a great first step by learning what evidence-based care means. However, here’s a little secret I’m going to tell you. Even though we have evidence for many treatment options, this evidence is not always used in practice. Sometimes your care providers might not know about the evidence, or they might choose to ignore the evidence. Why? We don’t know exactly why, but there are many possible reasons. It may be that some care providers are too busy and do not have time to keep up with the most up-to-date research. Or maybe they can’t access the evidence. Or maybe they just prefer to do things the way they have always done them.

So here is my homework assignment for you: Ask your care provider about the evidence. Whenever a treatment option is suggested, ask, “What’s the evidence for that? What are the risks? What are the benefits? Are there any other options that I should consider?”

Ultimately, I believe that the power to move towards evidence-based care is in your hands—the hands of pregnant women and their families. This past Labor Day, nearly 10,000 women in the U.S. rallied on the streets to raise awareness for the need for evidence-based maternity care. In 2013, we expect those numbers to double. I encourage you to educate yourself about evidence-based care and then get involved at the local or national level with ImprovingBirth.org, an organization dedicated to promoting evidence-based maternity care in the U.S. Who knows? Maybe, if enough women stand up to demand the best care—evidence-based care–we can make birth safer and better for us and our babies on a national scale.

Thoughts for discussion: Why do you think evidence-based care is important? Does knowing the evidence make you feel more confident in your choices?

 

Rebecca Dekker is an Assistant Professor of Nursing and teaches pathopharmacology to undergraduate nursing students. She recently received the Marie Cowan Promising Young Investigator Award from the American Heart Association, and she is principal investigator on a research grant from the National Institutes of Health. In 2012, Rebecca founded EvidenceBasedBirth.com and joined the executive board of ImprovingBirth.org—a non-profit organization dedicated to promoting evidence-based care for women and babies.

 

You can follow Rebecca’s articles on the Evidence Based Birth Facebook page

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Comments

  1. Thank you for what you are doing to improve birth for mothers and babies! Evidencebasedbirth.com is such a great resource.

  2. Thanks Rebecca, for sharing a bit about how you got here. I am glad that you have decided to offer your wisdom and time to share evidence with all of us! valuable and important for maternity consumers to know! Thank you!

  3. Sarah says:

    Thanks so much for this post! I love your blog and am glad to see the evidence being reviewed in such a way. I’d love to get in touch and discuss with you some ideas I have about my master’s essay (in public health) on evidence-based maternity care and whether the evidence we have – or don’t have – is appropriate, etc.

    I was also wondering what you think about using risk of ‘harm’ vs. benefit rather than simply risk vs. benefit, in the sense that risk conveys the likelihood and not the negative aspect in contrast to the positive aspect of ‘benefit’.

    Thanks again for your awesome work!

  4. Rebecca, your blog is excellent. Ensuring women have access to evidence based information is a key component for having a healthy birth. Even the definition of “healthy” is variable, depending on a woman’s care provider’s opinion. As an educator, I do my part. Every bit of information and confidence helps my students have better outcomes, and better birth experiences. So, thanks for helping to keep us all informed.

  5. Thank you, everyone! Sarah– feel free to contact me at evidencebasedbirth@gmail.com, I’d be happy to talk with you about your Master’s project! You raise an interesting point about the phrase “risk vs benefit.” Maybe we should re-phrase it as “weighing the likelihood of harm versus the likelihood of benefit.” But I also like your idea of “harms vs. benefit.” You’ve given me something to think about!

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