Tuesday, May 18, 2010

Evidence-Based: Important and Necessary...now!

The undercurrent of maternity care practice, whether one is a physician, midwife, nurse, childbirth educator, doula or lactation consultant, is the question of evidence based practice.
As defined by Childbirth Connection, evidence based maternity care uses the best available research on the safety and effectiveness of specific practices to help guide maternity care decisions and to facilitate optimal outcomes in mothers and newborns.
For independent practitioners, implementation of new practices based on evidence may not be as cumbersome as in large facilities or institutions. Researching and rewriting current policies, procedures and practice guidelines takes dedication to the health and well-being of mothers and babies, funding, time and consensus amongst those in the approval process. These long processes are a challenge to translating the evidence into practice and prolong the adverse reactions to increased intervention and keep the US maternal and infant mortality/morbidity rates in the substandard category.

Foremost in the minds of care providers must be the fact that for most childbearing women in the US (and for that matter world-wide), pregnancy and birth are conditions of health and most women are at low risk for complications. A broad knowledge base is needed to provide care and support for physiologic birth – an instinctual and hormonally driven process. The body has the potential of producing high levels of pain-relieving opiate beta-endorphins and endogenous oxytocin, which both facilitate labor and birth, inhibits postpartum hemorrhage and promotes fierce bonding and newborn wellness.

However, lacking from 99% of nursing school curriculum and residency programs are the skills necessary to promote physiologic birth. Underused practices include skilled labor support, facilitation of labor through the use of gravity positive positioning, enhancement of Second Stage through gravity positive positioning, labor comforts including aromatherapy, relaxation and hydrotherapy, delayed cord clamping and uninterrupted skin-to-skin contact.

Although not just iatrogenic, blame can also be placed in the area of inadequate informed consent practices AND a lack of preparation by expectant women and their partners. An embarrassing average of 25% of women attend any type of childbirth education classes in the US, enabling them to remain uninformed, unprepared and uneducated. With the biased view of birth presented by the media, clients come to childbirth education class with nearly ridiculous views of their body, pain in labor and birth itself.
It is evident that women do not know their options because they often do not have credible sources of information at their fingertips. What they read in books, hear in childbirth class, or are told by their care providers often clash and send the expectant mother into confusion ~ who can she believe, who should she believe?

Putting the mother or family between a rock and a hard place is our fault. There should be consistency in the evidence-based material given to women. And we should begin being consistent NOW!

1 comment:

Sarah said...

On the note of what women believe about their bodies: a friend was recently told that she wouldn't be grossed out by her outie-pregnant-belly-button if she understood its underlying purpose: to give her unborn baby oxygen. I kid you not. My friend tried to explain to the woman that the baby has her OWN umbilical cord through which the baby receives oxygen, nutrients, etc. through the placenta, but the woman was adamant that the baby receives oxygen through the mother's belly button.

The really bad part? The woman who believes that unborn babies get oxygen through the mother's belly button IS A MOTHER OF 3.