What do we mean when we talk about "evidence based birth"?

Posted on August 31, 2017 by SCV Birth Center

When you’re expecting and find yourself instantly inducted into the world of all things pregnancy and birth, you start to hear the the term “evidence-based birth” getting thrown around a lot. As birth workers, we understand what this kind of care looks like, what it doesn’t look like, and most importantly why it’s so beneficial to moms and babies. But what are we really talking about when we use this phrase? Is it just birth-people lingo for the ultimate birthing experience? Well, kind of.

 

But let’s break it down a little, shall we?

 

Evidence-based birth, at its core, refers to procedures being put into place that are actually supported by facts, statistics, hard evidence. It seems like that should be standard of care across the board, right? But often times, there are a lot of outside factors that influence birth, and not all of them are based on what the best tried and true policies and procedures are that lead to better birth outcomes. Sometimes, even under the care of highly trained and skilled providers, the so-called birth “politics” can get in the way of the procedures.

 

Why is this important? Because it can have tremendous influence on how a woman’s body responds to labor and delivery, what happens in the immediate postpartum, and how babies are cared for post-birth.

 

Many hospitals, or even birth workers who work outside of the hospital, use outdated or potentially harmful protocols that are not supported by evidence. Sometimes, this can mean a birth that requires a lot of intervention. It can also mean a longer recovery for mom and baby. While research routinely proves that the most scientific birth is actually the one where there are lower rates of interventions, modern medicine can’t seem to process this radical notion- that women’s bodies actually work pretty well on their own.

 

Certainly, there are times when birth calls for interventions, and it’s important to implements those interventions in the most beneficial way. But what we see often in maternity wards is cascades of interventions that lead to more interventions. We see high rates of cesarean birth, many of which happen unnecessarily, or as a result of the previous interventions being performed on the laboring mother. We see babies beginning their lives in the NICU, instead of on their mother’s chests. We see doctors railing against women’s choices, rather than supporting them in allowing them to listen to their bodies and give themselves what they really need during their births. We also see a new trend of PTSD (or birth trauma) in postpartum mothers who felt unsupported, pressured or coerced during delivery. We see low risk births becoming high risk births for no good reason.

 

Many standard procedures happening in maternity wards are not based on good evidence. We know that routinely manipulating women’s bodies can be dangerous. Procedures like early, unnecessary inductions, forcing women to labor on their backs, episiotomies, constant electronic fetal monitoring (as opposed to intermittent monitoring, which is proven to heed better results and is linked to lower cesarean rates), all come with added health risks. So why is this happening if we know it doesn’t lead to better outcomes or patient satisfaction?

 

There are a lot of reasons (none of them particularly good) as to why we don’t see evidence-based birth being embraced across the board. For one, birth that requires less intervention is usually less expensive. Whether we like to think of it that way or not, there’s a business to giving birth and the more manipulation, like pitocin, epidurals, c-sections, the greater the cost, and the more money the provider and the hospital makes.

 

There is also a great level of fear surrounding childbirth, and a cultural mistrust of women’s bodies that we see play out the moment a woman becomes pregnant. Suddenly, she must be subjected to countless tests and screenings and exams that she is told are happening to ensure the best outcome- only in many cases, the opposite proves true. The more intervention, even early interventions like invasive prenatal testing and multiple ultrasounds, doesn’t lead to better birth. Mostly, it creates even more fear surrounding birth. It leads to more unnecessary testing. It leads to more medical births, even when the evidence points the other way.

 

Finally, there’s another reason why this kind of birth is common and it has to do with convenience. While spontaneous birth is unpredictable, a scheduled birth on a set day, at a set time, means the delivering provider can plan to be there. While that planning involves heavily manipulating a woman’s body, and possibly forcing a baby out before they are ready to be born, it is certainly easier to plan than getting a phone call in the middle of the night that it’s time to come on duty. (At SCV, we don’t mind getting out of bed to deliver your baby, especially because we believe waiting for your baby’s birthday is pretty important).

 

While most providers have good intentions, some are simply more comfortable with more medicalized birth. No- it might not be based on evidence, but it’s birth that they are trained for and basically, understand how to handle.

 

But we believe wholeheartedly, that evidence-based birth is not only helpful, but it’s essential. Not only does it lead to better outcomes, lower rates of interventions, less birth trauma and lower rates of surgical birth, it leads to families starting their parenting journeys under the best possible circumstances. It leads to more calm births, more content mothers. So of course, we are happy to provide that care, and to help educate women about their choices in the process, and explain why we are doing what we’re doing every step of the way.

 

Your baby’s birthday is a day that you only get to experience once. So why not use all the facts, the evidence, and the support you can possibly gather in order to have an amazing birth. We know your baby’s birth is important to you. It’s important to us, too. That’s why we opt for facts, statistics, and patience in order to provide our clients with birth that is evidence-based, every single time.