February 2, 2018
Perhaps because of the difficult national conversation about the reliability of science and evidence, it shouldn’t have come as a surprise that some challenging questions came up in a recent childbirth class. One expectant father, clearly very attentive and supportive of his partner, kept asking the same question each time a new topic was discussed: “But is it evidence-based?”
It came up repeatedly–about eating during labor, inductions, the use of medications, c-section–he kept wanting to know whether our approach was “evidence-based.” He didn’t always seem satisfied with my answers and I realized that we were, in a very important way, talking past one another.
I believe that what he was looking for in each instance was a reference to some very hard, quantifiable or statistical information. I think there is a misconception that if something is “evidence-based” it will be universally and consistently true for every patient. When my answers were a little “squishier” than he wanted, I saw that what we really needed to talk about was the term “evidence-based” and how it relates to birth.
Rebecca Dekker, PhD, started the excellent website, Evidence Based Birth®, and speaks extensively about this topic. Her premise is that true evidence-based care is in the gray area where research evidence, clinical expertise, and the patient’s values overlap. Or, as she says, it’s like a three-legged stool.
Reliable research evidence comes in the forms of systematic reviews, randomized controlled trials, and observational research, among others. This is the kind of information my young father-to be was looking for.
But research evidence alone is incomplete–even meaningless, it could be argued—without the clinical experience of an engaged and attentive provider. How does the research apply to an individual case? Because every patient is different, with a unique history, a unique pregnancy, and a unique constellation of circumstances, a skilled provider can discern the most meaningful and relevant research evidence. And, last but in no way least, every patient has her own values and preferences to consider when making choices for her labor and birth.
Finding The Sweet Spot
So, if the sweet spot is in the middle, how can expectant parents approach birth most effectively? It all starts with good communication. Patients should feel comfortable and empowered to ask questions and get the information needed to make informed choices.
What are the benefits? (Why is an option being presented?)
What are the risks? (What will the impact on me/my baby/my labor be?)
What are my alternatives? (Is there another way to achieve the same result?)
What if I say no? (Or what if I say “not now?” Or “could we revisit the idea in an hour or two?” Or “could I have a few minutes to talk it over with my partner?”)
Does this feel right to me? (Is it consistent with my preferences? What does my instinct tell me?)
Of course, this good decision-making also relies on having a trusting relationship with a provider. It’s important to share values and preferences with providers so there’s context for the patient’s choices. Ideally, this conversation begins early in pregnancy. Let your provider know if you have strong feelings about any aspect of the birth experience and take the time to make sure your views are heard and considered.
In the end, while the intentions of the young man in class were excellent—to be a thoroughly informed advocate for his partner—he was only looking for part of the necessary information. There is no single “right way” to give birth. By looking at quality research evidence on the options during birth, trusting a provider to help navigate those options in a very personal way, and understanding that every woman has unique perspectives and priorities for her birth, new families can truly get “evidence-based” care.