How to Get Evidence-Based Maternity Care
Every mother wants the best for herself and her child, so of course she wants to make sure they both receive the best care during pregnancy, labor and birth. How can she make sure this happens? First, it’s important to understand what evidence-based care is and how it compares to routine care; then, we’ll outline three steps to ensure the most appropriate and safest care for you and your baby.
What is Evidence-Based Care?
Evidence-based care is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient.”* Let’s unpack that definition because there are two important elements here: (1) the care is determined by the most up-to-date research available, and (2) the care is appropriate for the individual at hand. Both pieces are equally important and should be used together to determine the best way to care for a mother during labor and birth.
In comparison, routine care is a term used to describe what is often the norm in U.S. hospitals; this care may or may not be supported by evidence from current research and typically is not tailored to individual needs.
Despite an ever-increasing understanding of how to keep mothers and babies safe and respected during labor and birth, routine care is not always in line with current evidence. Illustrating this distinction, Evidence Based Birth created the following table to show the differences between routine U.S. care and evidence-based maternity care:
How do you ensure you and your baby receive evidence-based care?
It can be both startling and upsetting to see such a stark contrast between care that is based in evidence and the non-evidence-based care that has become routine in many U.S. hospitals. The good news is that you can take steps to make sure that the care that you and your baby receive is both tailored to your unique needs as well as based in up-to-date research.
Here are three steps to ensure evidence-based care:
1. Know your rights
Your care provider is there to assist you in your birth; you have rights that cannot and should not be violated. Chief among these rights is the right to make an informed decision . This means that, “women have the right to […] accurate information about the risks, benefits, and alternatives to a suggested course of treatment, procedure, or medication, and the ability to accept or refuse that suggestion.”** At every point during your labor and birth, you are entitled to know why a procedure or intervention is being suggested and then to decide whether or not it is something you wish to do. For example, a healthy spontaneous labor may often be augmented (sped up) as part of routine care; however, this may be unnecessary and result in otherwise avoidable complications. A childbirth class can help you understand the typical labor process and the interventions that may be offered and it can teach you how to ask questions and speak up during your birth.
2. Know your care provider – and communicate candidly
Early on in your care, ideally even before you become pregnant, talk with your doctor or midwife about their philosophies about birth and what their practices are like during labor and birth. The details are important in determining whether he or she is compatible with your goals and values, as well as whether they place the same level of importance on evidence-based vs. routine care. Don’t be afraid to ask questions, especially if your provider brings up procedures or interventions that you are unfamiliar with or do not want. Trust your gut and don’t ignore red flags, such as a dismissive attitude or unwillingness to engage in such conversations. If needed, you can hire a new care provider that is likely to be more supportive.
3. Know your birth preferences
Your body is powerful, beautiful, strong and yours. Once you’ve gathered your information, learned about your care options and talked with your care provider(s), the decisions regarding your birth and labor are yours and your partner’s. Just because a procedure or intervention is “routine” does not mean it is necessary or even harmless. Write your birth preferences and share them with your care provider(s). If you’re not sure where to begin, the interactive Thoughtful Decisions booklet walks expectant parents through a step-by-step process. You can reference these preferences in labor if it is necessary to make decisions.
*Dr. David Sackett, http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036021
**“Your Rights.” Improving Birth. https://improvingbirth.org/your-rights/
Jennifer Stutzman, Freelance Writer
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