Thursday, May 31, 2012

Why Evidence-Based Practice is Important: The Hague, A New Book, and More!

Welcome to the final day of Childbirth Today's 2012 Blog Carnival - honoring the busy month of May and all of the celebrations of midwives, nurses, doulas and childbirth educators...AND mothers!  I will be closing this amazing month with a look at evidence-based practice, the Human Rights in Childbirth Conference at the Hague and the new book, Optimal Care in Childbirth: The Case for a Physiologic Approach.  

Thank you to everyone who sent in a guest post and for the thousands who read them!

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.

But it is not just in the US that professionals are talking about evidence.  Currently (May 31, 2012) the Human Rights in Childbirth Conference (  at the Hague (May 31 – June 1) is occurring to discuss and clarify the practical implications of the European Court of Human Rights 2010 holding that women have a human right to choose the circumstances and location in which they give birth.  Speakers from all over the world, including our own Ina May Gaskin, Jennie Joseph, Robbie Davis-Floyd, Barbara Harper, Barbara Katz Rothman, Dr. Raymond de Vries ~ and others such as Michel Odent will be in on this groundbreaking conference.  You can follow the activities by following their Tweets at #birthhr or attending their webinar (, both live-streamed and an online webinar afterwards.  Their Facebook page will also have updates at

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 25% of women attend any type of childbirth education classes in the US, making them 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.

If it is the evidence that you need to stay committed in the midst of adversity, there are several avenues to explore.  As stated before, Childbirth Connection is a valuable international tool from which to obtain information (  You can also find, coming tomorrow –June 1- Optimal Care in Childbirth: The Case for a Physiologic Approach by Amy Romano and Henci Goer.  This dynamic book should be on the shelf of every Labor/Delivery unit and every birth professional! (Read the reviews, including my own on their website  To order, click here  Bulk discounts are available!

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!

About the Author:
Connie Livingston has spent her entire adult life as an advocate for evidence-based care in obstetrics and putting this information in the hands of both expectant parents and birth professionals.  You can find her most often writing in her office or teaching a Lamaze Seminar or other workshop, but also online (Facebook, Twitter, Linkedin, and 3 websites:;;  And you may occasionally find her at the local Starbucks.

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