We in the independent childbirth field attempt to give honest, evidence-based information to the women and families that seek our expertise. We do this by staying abreast of the most current medical journals, Cochrane reviews, studies, findings, practices, protocols and policies of U.S.-based medical establishments, and the ACOG.
With that in mind, we will not hesitate to acknowledge that there is a great amount of evidence to show that our current methods of obstetrical care might not be serving women in their best interests all of the time. Unfortunately, most obstetrical practices, protocols, and stances are in place to protect the medical provider from litigation, not to protect the woman's best interests, health of mom, or baby.
I, like most doulas and childbirth educators, are not anti-doctor or anti-hospital - we are not even anti-intervention... We wholeheartedly HOPE, every time we pick up a medical journal or read the most current ACOG policies, that we will find the Obstetrical field is beginning to practice evidence-based medicine (EBM). Unfortunately, more often than naught, we don't see this.
The evidence in obstetrical research news supports a less interventive approach than what I currently see in the settings in my local hospitals as being statistically the safest option for both mothers and babies with normal pregnancies.
Pushed reviews some of the reasons why some medical studies can give unbalanced results, and why it is important to weigh the source and methodology of Obstetrical studies. For this reason, Cochrane reviews are one of the best sources of balanced medical research and information. Below, you will find some of the information that I often pass on to clients when they request EBM:
- routinely breaking the bag of waters during labor actually does more harm than good
- the use of continuous External Fetal Monitoring (EFM) did not reduce incidences of cerebral palsy (the primary reason EFM is used) but instead had a significant increase on the rate of Cesearean birth and assisted vaginal birth
- early skin-to-skin contact had greater benefits to a baby warmer alone
- delayed cord clamping improves baby’s health
- the risks and benefits of home versus hospital births are about equal
- induction of labor before 41 completed weeks of a normal pregnancy has no medical benefit
- there is not enough evidence to support using active vs. conservative management of fetal distress is a benefit
- benefits to giving birth off your back include less pain, better fetal heart rate, less forceps deliveries and less episiotomies
- Late-pregnancy (after 24-weeks) ultrasound increases unnecessary cesareans and has not been proven beneficial
- there is not enough evidence as to the safety of misoprostol for induction of labor
Neonatal Mortality Rate (rate of death in the first 28 days of life, per 1000 live births):
The United States ranks behind Iceland, Singapore, Japan, the Czech Republic, Finland, Monaco, Norway, San Marino, Slovenia, Sweden, Belgium, Cyprus, France, Spain, Andorra, Austria, Denmark, Germany, Greece, Israel, Italy, Luxembourg, the Netherlands, Portugal, Switzerland, Austria, Canada, Malta, New Zealand, the United Kingdom, and Belarus. We are number 31.
Maternal Mortality Rate (rate of death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy, per 100,000 live births):
- Ireland - 4
- Finland - 5
- Spain - 5
- Austria - 5
- Italy - 5
- Canada - 5
- Australia - 6
- Denmark - 7
- Switzerland - 7
- New Zealand - 7
- Qatar - 7
- Sweden - 8
- Portugal - 8
- Czech Republic - 9
- Germany - 9
- The former state union of Serbia and Montenegro - 10
- Japan - 10
- Norway - 10
- Belgium - 10
- Greece - 10
- Slovakia - 10
- Croatia - 10
- Poland - 10
- United Kingdom - 11
- Hungary - 11
- Kuwait - 12
- Israel - 13
- The former Yugoslaw Republic of Macedonia - 13
- United States of America - 14
Bottom line, we have MAJOR room for improvement.
As a doula and childbirth educator, my number one role is advocacy. It is not telling a woman what she should do, what she will do, or making choices for her. It is not speaking to her medical team on her behalf, but equipping her with the information necessary to make the best, most informed choices so that she can make these choices for herself. One birth at a time, we strive to make births SAFER through encouraging EBM and informed decision making.