In this episode I cover:
What is evidence based care?
Why you need to advocate for it.
One thing hospitals do routinely that goes against the evidence.
How you can be more informed.
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Hey moms, welcome back to the Expecting Mom Podcast. I am here for episode 2 of our mini training. This is my birth mini series that is leading up to the opening of Unmedicated Academy. If you’re enjoying this series, please do me a favor, leave me a rating on iTunes. Or even better, take a screenshot and tag me in it, share it to your Instagram so I can shout you out. It really helps me to reach more moms, and help more moms learn about physiological birth. And it helps me continue to work on this podcast and provide you guys with free information and education.
Okay, so today’s topic is evidence based care. Maybe you’ve heard of the term evidence based care, but like, what is it? When you hear that, it seems like Well, duh, I want care that is based in evidence. So like, what do you need to know about evidence based care? What are hospitals doing that’s evidence based? And how can you be more informed on evidence based practices? So the definition of evidence based care is that evidence based care is a combination of best research evidence with clinical experience, and the patient’s values and preferences. So that’s really important, because it’s not just this is what the science says, Okay? It’s the research evidence, it’s the clinical experience. And it’s what you prefer, and what’s important to you.
So evidence based care means that you’re receiving full, accurate evidence based information to help you make your decisions based on your values and your preferences. It means that your provider pays attention to the evidence, and tailors your care to what your values are, and what your preferences are. So this is really important, because the first thing that comes to my mind is the really popular ARRIVE study. And this study, basically came to the conclusion that inducing at 39 weeks, lowers your chance of cesarean. But there’s two things that really stick out to me as a reason that I personally would not like, take that study to heart. So even though the evidence says that, you know, there’s a little bit of bias in there, because the providers knew that they were doing a study, so they were probably a little more patient with the inductions. And that probably lowered their failed induction rate. So it’s not really an accurate picture of what’s happening in hospitals. And then the other thing is that the women in the study had to opt in to the study. So they had to agree to either be induced at 39 weeks or agreed to be induced at 41 weeks. And that’s the comparison that they were making. If you want a physiological birth, you’re not going to agree to that I would not agree to being induced at 39 or 41 weeks because I want my body to go into labor on its own. You know, if you listen to the episode 8 on What is physiological birth?, you know that the best outcomes come when we don’t interrupt our body’s normal birth process. So really, the ARRIVE study does not apply to women who want a physiological birth because it’s a medicated birth experience. So if a woman wanted a physiological birth, they probably would not have opted into this study. So the these outcomes really don’t apply to a woman wanting an unmedicated birth.
And really an induction is not great if you think of maternal satisfaction, women who are induced that want unmedicated labor’s do not like those births where they have to be induced Pitocin is a b*tch. And most women that have had a Pitocin induced birth, try anything and everything to not have to do that again. And really there’s a lot of things so the study is that Pitocin can decrease your risk of cesarean at 39 weeks and providers use this line a lot and they love to induce at 39 weeks, but there are a lot other things that you can do to lower your risk of a cesarean, that is not induction. Okay? So keep that in mind. Let’s, I’m going on a tangent, so let’s rein it back in.
So what’s the problem with evidence based care? So, it, there’s an evidence practice gap, it takes 15 to 20 years to get evidence into practice. So that means that your hospital might not even be doing evidence based practices. So when you think of evidence based caring, you say, duh, like, Duh, I want that. Are you actually getting that? You might not be. So you really need to know well, what does the evidence say on some of the standard protocols? And is my hospital doing that, because you might have to ask for what is evidence based hospitals very often make their protocols for liability reasons, not necessarily for what has the best birth outcomes. So they are trying to head off any problems, even before they become a problem. One example is fetal monitoring. So 89% of hospitals use electronic fetal monitoring, even though the evidence shows that the routine use of electronic fetal monitoring without medical indication is not evidence based.
So let’s digest some of that. Routine use means hospitals, when you check into the hospital, you are on electronic fetal monitoring. Regardless, everyone gets it. Even if there’s no medical indication, meaning, you know, mom is low risk, baby is doing fine. There’s nothing that shows that we need to be continuously monitoring the baby. And so hospitals are just doing that right away. Everybody needs to be monitored the whole time without taking the monitors off. And really, that’s something that should be reserved for more higher risk situations. So the the alternative option to that is intermittent auscultation, I think I’m saying that wrong, I don’t have it in my notes, but using a Doppler to intermittently check on the baby’s heart rate. So you’re still doing fetal monitoring, but it’s not electronic. It’s not the straps on your belly, the providers coming in and checking you every so often intermittently, so that you don’t have that restriction of movement. And the outcomes are just the same. There’s no more risk to to maternal and fetal outcomes when you do that sort of monitoring. So these alternative options actually show better outcomes without additional risk. And this is what evidence based is, so it means that they that we have better outcomes with no additional risk. And a lot of times we’re not doing these things routinely.
So why why is there a gap in what the evidence says, and what the providers are doing? Like the fetal monitoring? Why is everyone doing continuous fetal monitoring versus intermittent, intermittent fetal monitoring, electronic versus handheld? So I know there’s many care providers who are doing more evidence based practices. And that’s wonderful. But others have definitely been slower to make the switch. And that one example of fetal monitoring goes is perfect illustration, because almost 90% of hospitals are not are are doing electronic fetal monitoring. So research there, there is a study that shows why care providers don’t always do put evidence based practices into their routine. And there’s a lot of reasons. So some of the reasons that came up in this survey is one they don’t know about the evidence. They don’t know what is evidence based, they’re not doing the additional research, they’re not looking into the new studies, they’re just going along with what they’ve been doing this whole time. To they don’t believe the evidence. So they believe what they do works, and they don’t need to change it. Or they don’t have confidence in their ability to make that change. So they they feel confident in what they’ve been doing. And the change makes worries them you know, we do have to remember that providers are humans, and they they really are trying to, in most cases, have best outcomes for baby and for mom. And so it’s it is scary for them to change what they are used to doing.
The next thing is they don’t think it will make a difference to change. So they think that just changing, these few things will even make a big difference. They’d rather stick with the status quo, what everybody else is doing. They don’t want to give up the way that they’ve been doing things. So So those are some reasons why there is such a big gap in what’s been practice, and what is actually evidence based. So what can you do? What can you do if you’re going to have a baby in the hospital, and you want more evidence based care, you want care that they’re not providing.
So they’re not doing the evidence based care and you want to go against what their protocol or their routine is, you need to be really vocal about wanting evidence based care, you need to help bring the evidence to your provider, you know, have some backup, I want this XYZ care, because studies are showing that outcomes are just as good. There’s no increased risk. And it aligns more with my values, specifically speaking, on moms that want that physiological birth, okay, so a lot of the protocols that are in place in hospitals are very, very medicalized, and kind of go against what supports physiological birth, which we did talk about in the episode prior to this episode 8. So go check that one out, if you haven’t listened yet. So you need to make sure you’re learning the evidence for yourself so you can advocate for a better birth experience for you.
And that’s exactly what we do in Unmedicated Academy. In the second module, which is called Empower, it’s all about knowing your options, and knowing what’s evidence based and knowing what supports physiological birth, so that you can choose the best things that align with the kind of birth that you want. And we do an informed intervention workshop where we kind of walk through all of the common interventions that happen when you give birth at a hospital, and how it may or may not support physiological birth, and alternatives based on the evidence based on your preference of going unmedicated so that you can be informed so you know exactly what type of care that you want that aligns with your goals and your preferences. And then, with that workshop, we also have the labor research library where I give you all of the evidence based information so that you can dig a little deeper or you can take that information to your provider. Should you need a little bit more. I don’t want to say like backup, because ultimately it’s your choice, regardless of what the evidence says regardless of what the protocol is. If you say I want this done to my body, or I don’t want this done to my body, that’s all you should have to say. But sometimes it is nice to have that evidence to back you up.
That’s all I have for this episode. I’ve already well I haven’t finished the mini series on my IG TV yet. Next week, I am going to do the four rules of labor positioning which is one of my most requested mini training. So that will be on my Instagram next week and I will bring it over here to the podcast. It’s just slower going with updating the podcast because of all the stuff going on behind the scenes with launching my course Unmedicated Academy. I will link to the waitlist for unmedicated Academy so you can learn a little bit more and get on the waitlist if you’re interested. And make sure you are on my VIP moms list. So you get all the updates. You get me in your inbox every Monday and you don’t miss anything. Alright, that’s all I have for you moms. I’ll see you next time.