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Evidence Based Care for Birth: The Three Components

Evidence based care (practice or medicine) is a term that is used a lot these days when it comes to birth. What exactly does that mean?

You can see by the diagram that it is where the three factors intersect.

  • Individual clinical expertise
  • Best external evidence
  • Patient values and expectations

The first step, even before you choose your clinical care provider, is to figure out what your values and expectations are for your pregnancy and birth. This will likely involve some soul-searching.   It will involve you learning about what’s happening with your body, and how to take care of yourself.

Learn what you can about birth, watch positive birth videos, and speak to others who have had positive birth experiences.

Check out the hospitals, and birth centers in your area. Learn about homebirth. Be open to exploring all options before you rule anything out.

Think about these questions:

How do you view your overall health?

Do you use western medicine frequently? (doctor visits, prescription drugs, over the counter meds)

Do you generally eat healthfully and exercise?

Do you know what best practices (produce the best outcomes) are for pregnancy and birth

Can you tell if the information you receive is factual?

What are your desires for your birth?

Once you establish or discover what is most important to you, and you have done some soul searching and inquiry about the birth process, it is time to choose your clinical care provider. This will be someone who matches up with your values and expectations. Someone who will answer all your questions and will be respectful of your choices.

Your care provider should know what the latest, best available evidence based care is. For example, if you hear that you can’t eat or drink while in labor, this is not evidence based care. It is protocol (a standard of practice that is not supported by evidence necessarily)

You can say yes or no to everything. I was at a birth once where a woman was 10 cm dilated, ready to push. She requested epidural, and I thought for sure the doctor would say it was too late.

Because the woman insisted, and wanted the epidural, she got it.  In this case, evidence based care would suggest that when a woman’s cervix is completely open, it would be time to push her baby out, not time for an epidural. Patient choice took priority over clinical expertise, and best external evidence.

What happened to the point where they intersect? Should the care provider have explained to this woman that her body was ready to push out her baby?  That having an epidural at the point of pushing would prolong that stage?

I would say yes!! While your autonomy is most important, it is also the job of the clinical expert to know the best external evidence, and be able to use that in the best interest of you; the individual on the receiving end of the care.  It is always about optimal outcome.

Pregnancy and birth are not illnesses. They are viewed that way in the United States, and are then treated from that perspective. The important thing to remember is that you are in charge, you can choose what you want, and your care provider will ideally be the one to help you evaluate. Be sure you trust that person completely, which means trusting your own guidance system.

There is a lot of information everywhere about pregnancy and birth, and it can be overwhelming.   Take time to process, and time to sit quietly to listen for answers.






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