Evidence based Research: Implementation delay or refusal?

While updating The Birth Facts recently, I was once again surprised and delighted to see the vast amounts of evidence based research for physiologic birth.  Yet in the same instance, I was dismayed that these practices with such carefully conducted studies have yet to be implemented in US hospitals, which is my immediate frame of reference - yet I am also aware of the fact that these practices are not completely implemented in hospitals in other countries (thanks to posts from FB friends).

Refusal or delay in implementation of evidence-based research is a huge question.  Not necessarily why it takes so long (delay) - it is usually within a hospital setting with humans and both of those factors make for lengthy decision/discussions.  Refusal is a whole different perspective.  And begs the question: why would an institution (not to mention individuals) which stands for health and well-being, refuse to implement evidence-based research into practice?

If, as Freeman stated in his piece "Why general practitioners do not implement evidence: qualitative study", Evidence is not implemented in a simple linear way, as some definitions of evidence based practice imply, but in an evolving process whereby reciprocal contributions from the doctor and the patient over time influence how evidence ultimately is used, then it would seem that our foremothers in childbirth education were correct and it is the consumer/patient/expectant mother who will be the driving force in making informed decisions that will influence evidence-based practice implementation.

However, if that consumer/patient/expectant mother is not enlightened regarding the evidence and also their own power for practice change, then further delay in implementation will be seen.

Perhaps birth professionals have been going at this all wrong?  Or at least partly.  Through social media and classes, we disseminate evidence-based information, perhaps we should also be disseminating information on how the consumer can make the changes happen....and faster?  Yet we must not only say that consumers are change agents but give expectant mothers and families ideas of how to positively influence their care environment.  

Forty years ago when the first real consumer movement in birth occurred, women were empowered by others on how to be a change agent.  I am not just talking about burning a bra here and there, but encouraging them to speak up if something was not right.  A movie frequently shown in childbirth education classes in the 70s and 80s was "Nan's Class".  The movie followed a Lamaze Childbirth Educator, Nan, and the six couples in her class.  I will never forget lines from that movie: "If things aren't right, speak up!" she would tell her class.  

A father states, “Childbirth is not an experience of illness, it's an experience of health.” Nan reaffirms his idea through her attitude and the way she presents information.

IMHO, we birth professionals have taken a giant step away from empowerment under the guise of "let the consumer decide".  While that is fine, and the way it should be, birth professionals need to marry the evidence-based information with fundamentals of empowerment.


References:

Freeman, A. and Sweeney, K. (2001)  Why General Practitioners Do Not Implement Evidence: a Qualitative Study. British Medical Journal November 10; 323(7321): 1100

Shilling T. and Bingham, S. (2010) Revisiting the Classics in Childbirth Education. Journal of Perinatal Education. 19(3): 73–78.