The Hardest Road

Almost every week there is some Conference or seminar promoting evidenced based birth . Or someone is screaming that some procedure or other is not  “evidenced based”. So what does “evidence based ” REALLY MEAN? Well in a scientific experiment it means for one thing the result can be replicated over and over if the exact thing is done and in medicine or midwifery if the physical circumstances are similar. Or it proves that some chemical be it drug, herb, food or toxin causes harm in some way and this result can be shown as cell damage or injury or illness or just no result or adverse results that are consistent from body to body. The problem is much of what we do in obstetrics is never tested, duplicated or the problem has so many variables the results are mixed…Sometimes a procedure helps , sometimes it is not clear. Then Doctors go to an institution like the Cochran data base and mix up the results from many studies and try to find consistent results. This is a study of multiple studies that are different with different parameters. So the real “science” becomes very occluded. Moreover Midwives and doctors a like view hundreds of studies of one thing or another and put those studies as references to ‘Prove” a certain viewpoint that is believed by personal experience and bias to be  “true”. So what are parents to believe in the age of the internet, a flood of information about issues having to do with pregnancy ,birth, newborns and children, women and family health care. Here is the way I “judge”..1)What is a given study looking at exactly. for example there is lots of information on the internet spoken with great passion about the benefits of eating placenta capsules. Many impressive testimonials are out there. Studies are quoted. One out of Utah tha doesn’t study safety or effectiveness but who is processing and eating placenta pills. It is a sociological study of who is encapsulating their placentas and eating the pills.2) Giving oxygen to the mother in labor for fetal distress “makes no difference” in survival or outcomes. Numerous studies say this a Cochran Data Analysis agrees, a prominent L.A. O.B. agrees. But these studies were all based on Apgar scores of labors where O2 was administered and NOT administered. Where as a2006 Study by Dr. Negeotte and others showed but fetal blood analysis one could raise the oxygen in the fetal blood 13%- 22%by studying the blood itself. In the most oxygen deprived babies it helped the most by giving the mother )2 at 8-10 liters a minute by tight fitting facemask. A study that actually examines the physical evidence is scientifically MUCH stronger than those that just analyze short term outcomes. So next look at the analysis itself. The tragedy of this philosophy is many babies suffered longer and lower oxygen loads in their blood and in some cases it might have enabled vaginal birth or a better neonatal or even longterm outcome. 3)Then look at the size of the study, the follow up. This is especially important with the use if drugs. Remember herbs, homeopathics , food remedies have very little hard science behind them because doctors and institutions don’t get paid for testing them. Many have long folk science and histories though and in addition often characteristics and levels of some chemical or other can be found in biological journals. This IS a form of evidence and every once in a while an herb or food is so consistently effective it is tested for example oatmeal and cholesterol lowering in the blood, garlic as a blood thinner. Many other examples can be found. My rule for this is Test of time and continue to look for related biological studies.4) Does it make sense? Does some action or treatment seem logical, correct? If no matter how much you read and study something it just doesn’t make probably is incorrect. I see this every day with actions of midwives and doctors. One of the biggest myths is that fetal monitoring proves a baby needs to be delivered by cesarean.. It does not. It is a diagnostic  albeit more competent one of the oxygen loads of the fetus. But many midwives and most doulas look at dips on a fetal monitoring strip as the false justification for cesareans and simply dismiss monitoring all together. So a monitor is called an  “Unnecessary intervention”. It certainly can be.  But when it is needed it should allow anyone to see the difference between temporary stress and a baby that is staying in trouble and not recovering or worse crashing and really does need to be birthed by the quickest route. Use technology when needed  or when diagnosis is hard and remember there is a difference between a diagnostic and an intervention. If we diagnose correctly the baby is doing well we don’t need to hurry birth or do a cesarean… Does procedure or policy (all based on “evidenced based” medicine) make since or not? Something that is true will stand the test of time, it will make since. 5)Many are quick to find studies that prove some idea or the other but look at the outcomes and long term outcome. look at all passionate opinions wit care. You can figure out whether assertions of something being correct because they are “evidenced based “are true or not. It is hard to do all this but so worth it! Tonya Brooks

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