Wednesday, August 15, 2012

Evidence-based Care and Current Practice: Crossing the Great Divide

Be it published in the Journal of the American Medical Association, or a survey from the CDC, there is a gap in the United States between evidence-based practice and what is commonly seen in hospitals and termed current/best practice…or more correctly called current culture practice.

Obviously the facts about the relationship between high intervention rates and high maternal mortality/morbidity and infant mortality/morbidity rates bears repeating.  But the question is, is all of the repetition doing any good?  Since the above sets of rates keep rising, repetition is doing no good at all.

Over 2500 facilities (or approximately 82%) responded to the Center for Disease Control’s mPINC (Maternity Practices in Infant Nutrition and Care) Survey in 2007.  The results of the Survey found that a large portion of responding facilities used care practices that are not evidence based and interfere directly with breastfeeding.  Articles in JAMA, the British Journal of Obstetrics and Gynecology, the Journal of Pediatrics, JOGNN, the Journal of Perinatal Education,  and publications by WHO and UNICEF confirm that many “traditional” birth practices interfere with the body’s function during labor/birth, hormone releases, breastfeeding and skin-to-skin/bonding.  And yet, our national statistics for which traditional care or best practice is said to improve, remains humiliatingly poor.

The arguments are many.

“That’s the way we’ve always done it” is a resounding response when traditional practice is challenged. The same policies, procedures and practice guidelines have driven the care of facilities for years and to change would be a major consumption of time (time = $pay). 

Since it’s been working, why fix something that isn’t broken is another response.  After a lengthy review of the country’s statistical data, can one honestly say the system is not broken?

Mothers are not asking for change.  It is difficult for change to occur when Birth Plans are torn up infront of mothers and statements such as “This is just another plan for a section” are muttered.  It is difficult for change to occur when not only are childbirth education classes discouraged but ridiculed. It is difficult for change to occur when so many roadblocks to change stand in front of expectant parents.

There is not research to substantiate a change. Copious research is available in hard-copy print and online, including the WHO Joint Interregional Conference on Appropriate Technology for Birth, the Cochrane Database, the Baby Friendly Hospital Initiative, A Guide to Effective Care in Pregnancy and Birth, the aforementioned mPINC study through the CDC,  Impact of Birthing Practices on Breastfeeding 2nd Edition, and the new Optimal Care in Childbirth: The Case for a Physiologic Approach.  All of these mentioned (and many more) contain research evidence to support a change in maternity care.

We wouldn’t know where or how to begin.  Itemized clearly on the website for Childbirth Connection ( are the amazing blue print  and tools for transforming maternity care!  Additionally the US Surgeon General placed a call to action in January of 2011 to make breastfeeding easier and raise the breastfeeding rates – how better to do this than to improve a woman’s chances of breastfeeding through prenatal education and labor care practices conducive to breastfeeding? 

According to “Transparency in Maternity Care: Empowering Women to Make Educated Choices” (Journal of Perinatal Education 2008 Fall; 17(4): 8-11), “In 2001, the Institute of Medicine (IOM) published a report wherein they called for an overhaul of the U.S. medical system and identified transparency as one of the 10 necessary steps to achieve system-wide improvement. The IOM (Institute of Medicine) report states:  In 2006, The White House released an executive order calling for increased transparency in health care.”   So far, The Birth Survey has been able to shine some light on maternity care practices in the US so that expectant parents are not in the dark about local health care practices. 

What can one person do? In one corner of the community?

1 1.  Put together a FAQ sheet of books, journal articles and website addresses that support improving US maternity care, including the Health Birth Practices . Carry copies with you everywhere.  Hand them out to clients in childbirth education classes, doula clients and lactation clients.

2.    Be an advocate for education in your community.  Sponsor small but frequent workshops with guest speakers.  Invite local health care professionals.

3.    Have a birth movie night – show exciting movies such as “the Business of Being Born”, “More Business of Being Born”, “Pregnant in America”, “Orgasmic Birth”, or “Doula The Ultimate Companion”.  Have your local library order these movies to have in their collection.

4.    Start a Birth Book Club, inviting both professionals and parents to give their opinions on current birthing books.

5.    If you have a Facebook page, promote news articles and journal articles that focus on evidence-based maternity care.

6.    Call local attention to national/international celebrations you can use to help spread the word.  World Breastfeeding Month (August) is another great event on which to focus attention!

7.    Don’t give up and don’t think that a small contribution is too small.  Apathy and complacency is the worst enemy to any cause.  Be a voice.  Be a conduit.

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