Standard of Care Series Intro
Today, I finished Rebecca Dekker's Babies Are Not Pizzas, and I loved it so much so that I decided to do a series of posts inspired by the book. For the next couple weeks, we will take a look at what may constitute standard care in a hospital setting.
Please note that these are not blanket statements, and that hospital practices vary widely. Some hospitals have worked hard to incorporate evidence based care as a standard. That said, there are still many hospitals that have standard practices or policies that are not evidence based. (Reasons why you'll want to take the EBB Childbirth Class. 😉)
In the first chapter of the book, Rebecca shares the birth story of her first born. This birth experience would be the catalyst for the foundation of Evidence Based Birth®. There were various aspects of her care during this birth that she questioned. Was being confined to a bed really necessary? Why was eating and drinking prohibited? What was the evidence behind all the interventions suggested and even pushed? In the second chapter, she explores the evidence behind the standard of care she (and countless other birthing people) receive in the hospital setting. It is these practices that we will be exploring over the next couple weeks, just as she does in chapter 2.
Before we dive into the evidence, however, it is important to understand why there may be a discrepancy between what the evidence says and what routine care looks like in a hospital setting. Did you know that it takes, on average, 15-20 years after something is proven in medical research before it becomes used routinely in hospitals? There are a lot of standard practices that are still in place today in hospitals that are based more on tradition, doctors' opinions, fear of litigation, financial incentives, etc. than evidence. So what can you do to procure evidence based care?
The first thing to do is to sign up for the Evidence Based Birth® Childbirth Class, the Savvy Birth Parent Workshop or Savvy Birth 101. (Not local? Visit the EBB Directory to find a class near you.) Regardless of whether or not you've given birth before and regardless of your provider/birth setting, the information and knowledge gained from these classes is invaluable. Then, after registering for one of the above, get your hands on a copy of Babies Are Not Pizzas and start reading. Rebecca's book is eye opening and relevant to *all* expecting families. She tackles the aspects of birth that need to be discussed and recognized by our society without shying away from the tough topics. Her passion for her work is evident throughout the book. I promise you will not be disappointed.
Evidence Based Care
Before we go forward and dig into what the evidence says about some of the most common standard birth practices in hospitals, it is important to understand evidence based care. “Evidence based care is defined as using research to help inform medical decision-making, considering the health care worker’s expertise and the patient’s values, goals, and preferences” (Dekker, 2019, p 19).
It can be helpful to think of evidence based care as a three legged stool. One leg is comprised of the research evidence, another by the experienced provider helping you to weigh the evidence for your individual pregnancy and birth, and the third is your values, goals, and preferences. If one of these legs were taken away, the stool would fall over.
For example, tomorrow we will be looking at eating and drinking in labor. Spoiler: research shows that eating and drinking in labor is safe (the restriction on oral intake originated in the 1940s during the Twilight Sleep era of birth, and it is no longer an evidence based practice even though most hospitals still have this policy in place). So knowing that the evidence says it is safe for you to eat and drink in labor, you take this information with you to your next prenatal appointment (EBB has a beautiful one page hand out you can even print out and bring to an appointment with you...but I digress). Unfortunately, your provider feels strongly that the hospital’s policy of restricting oral intake during labor is for the best and should be upheld, regardless of your desires to eat or drink during labor. In this case, not all of the three legs of the stool are in place and evidence based care is not occuring. As a side note, this is why being choosy about your provider and birth place is so important, but that is a whole other post. ;)
All three of the legs are equally important in ensuring evidence based care is received.
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