Wednesday, November 28, 2012

They All Want You To Ask The Hard Questions But They Don't Want To Hear The Answers

It isn't easy being an advocate for evidence-based maternity care.  

Why? Because it an advocate speaks the truth...the evidence-based truth.

On the surface, the "they" we all encounter want to have best practice.  They want to jump through all of the hoops to be a Local Leader or Credentialed, Certified or Approved.  Being an advocate involves asking
"them" the hard questions.  Hard questions such as why is that a practice guideline or what evidence is used to substantiate it.  But rarely do "they" want to hear that "their" best practice is not evidence-based, in the best interest of mothers and babies.

"They" also really don't want their decisions or practices questioned even though they want transparency and want everyone's opinion to be heard and respected.  Of course, that is the statement that they repeat over and over but do not embrace and do not own.

Being an advocate is a lot like being a mirror.  "They" don't want to see their reflection.

Perhaps it is because their reflection is not one that actually solves any problems.  As mentioned before in countless entries of this blog, the statistical data on childbearing in the United States is not one that we can be proud of.  Our breastfeeding statistics are slow to improve but not at the rate that logic would have it.  When you examine the research, as was recently done in the outstanding book, Optimal Care in Childbirth: The Case for a Physiologic Approach, the research does not hold up both types of care models currently being used, the medical model and the physiologic care model.  To quote authors Romano and Goer, "The two models also diverge in whose needs and concerns take precedence.  The medical model centers around the doctor and institutional staff."..."In marked contrast, the physiologic care model puts the woman at the center.  Mother and baby form a single, inextricable unit; what is good for the mother becomes, by definition, good for the baby."

Seems simple enough right?  We need to put the health and well-being of mothers and babies first. Ignore the law suits and the economic incentives of long labors, the use of medication/anesthesia or admissions to the NICU.  Wasn't the fact that now with the Internet and easy access to the Cochrane Database and National Institute of Health, the era of evidence-based practice was to be the panacea of all of the problems with maternity care? Well, it hasn't been.

In searching for encouragement, I stumbled upon a rather lengthy excerpt from Optimal Care in Childbirth: The Case for a Physiologic Approach.  They write: "We, along with other advocates for maternity care reform, expected that evidence-based medicine would be the antidote to opinion-based practice.  Science, not what a Lancet editorial scathingly called "GOBSAT" - Good Old Boys Sat At Table - would dictate care practice." Yet contrary to our hopes, even the evidence has been used to substantiate medical management model.  But all is not lost, as I was beginning to feel and have seen others feel.  Romano and Goer continue, "Despite the deck being stack against physiologic care, we must not give up.  The stakes are too high.  The financial costs of medical management to society are enormous - just reducing the cesarean surgery rate to the World Health Organization recommended 15% would save $3.4 billion dollars annually.  The human cost is also enormous.  As a result of overzealous use of technology in labor and birth, millions of women and babies have suffered, and all to many have died.  Without a doubt, being a change-maker is likely to be frustrating and difficult, but when the health and wellbeing of childbearing women, babies, and society is at stake, no effort is too great, no accomplishment that forwards that goal too small."

I encourage you to read or reread Optimal Care in Childbirth: The Case for a Physiologic Approach as I did.  Shove the apathy out the door.  Grasp the mirror firmly in both hands.  Let's go.


LaurieG said...

Connie, thanks for the image of taking hold of my mirror in both of my hands and heading to my clinic... birth imagery DOES work!:) grateful for you.

Connie Livingston said...

LaurieG. Thank you so much.