Updated: Jun 9
Emily Sheppard – Hypnobirthing Haven, edited - 09/06/2021
Is Maternity Care Based on Evidence for What is Right for Me and my Baby?
Unfortunately the short answer is NO, it isn’t!
Of course this is not the case in all aspects of maternity care and in some areas it is definitely improving for the better, albeit slowly. Even with new research and evidence, it takes a long time for NICE and/or RCOG guidelines to be changed in line with the findings and even then, it is up to individual hospitals/trusts as to whether they change their own policies in line with new guidelines.
At present, individual trusts maternity policies, have an evidence base of around 18%* which means that a whopping 82% is not based on GOOD quality evidence. So what is that 82% based on then? I hear you ask………. Well a combination of things really!
Some policies/routine interventions are there just because that’s the way it has been done for eons (they might not have had the good quality evidence to back up the decision to implement the policy/routine intervention in the first place, but they now need GOOD quality evidence from specific research to change it!!!)
So how did these policies get decided in the first place? Some from “expert” opinion, possibly taken from small scale studies with poor evidence bases (one example of this would be vaginal examinations (VE’s) and Friedmans Ceurve aka the progress (or failure of) labour but I will save that for another blog) and some from professional experience and intuition.
What might be the biggest point of contention, (at least for me) is the fact that policies are also based on a business model of labouring women being put on a “conveyor belt” to get their babies born as quickly as possible, thus freeing up a bed for the next labouring woman.
But why is this the case? Why is there not more research so policies can be changed for the better? These are questions I get asked by my clients all the time and in her book “
Why Induction Matters” Rachel Reed explains it perfectly:
“Maternity services claim to be ‘evidence-based’, and this term is usually used to refer to research rather than other forms of evidence, such as experience or intuition. However, there are a number of problems with research evidence in maternity care. Routine interventions, such as induction, were introduced as part of the general medicalisation of childbirth, without any supporting research. Once routine interventions were established, they became the norm within hospital practice. These practices continue today until there is good-quality research evidence to support a change. For example, until the late twentieth century women were routinely given an enema and perineal shave during labour. This only changed when research demonstrated these interventions were unnecessary and potentially harmful.
However, undertaking good-quality research into maternity care is difficult because it requires a lot of funding. Research funding is usually provided by government organisations, or the pharmaceutical and medical technology industries. Access to government funding requires research to be aligned with current health care priorities. Health care priorities tend to focus on diseases such as cancer and diabetes, rather than on maternity care. Funding by industry can alter how research is carried out and what findings are published, because industry has a vested interest in securing a positive outcome for their product. The limitations of research funding mean that there is very little unbiased, good-quality research [in many aspects of maternity care.]”
“So”, I hear you say, “its not all evidence based but surely my care will be individualised to my personal situation?”
Again, I am sorry to say but the short answer again is, NO, it won’t necessarily be. It is a ‘one size fits all’ model of care and often individual circumstances are not taken into account when it comes to routine intervention. Of course, there will be times when the benefits outweigh the risks in a proposed intervention and we are lucky we have the expertise there when medically needed as it does, absolutely save lives. But the problem comes when it is because of a ‘routine’ intervention. When it’s just because the hospital’s policy says that’s how it’s going to be done.
When interventions are routine, and individual circumstances are not considered, it may be that the risks actually outweigh the benefits of the proposed intervention and that continuing with the pregnancy (or labour) without the intervention, may be the safest and best option if mum/birthing person and baby are happy and healthy.
If you are not given ALL the options, you cannot give informed consent.
So how do we change this? How do I ensure that I receive the care that is right for me and my baby?
Most importantly, YOU ASK QUESTIONS!!!
Don’t be afraid to ask your health care provider as many questions as you like so you feel you have enough information to make an informed decision for what is right for you and your baby!
Do your research!
Arm yourself with knowledge to empower yourself. Read the books or even better, do a complete 12-hour Hypnobirthing course with me, Emily Sheppard, that covers what you need to know about labour and birth and how to help you achieve the relaxed, empowered and positive birth that is right for you! You can find out more and book here:
Talk with your birth partner about your preferences so they are able to advocate for you, maybe even think about hiring a birth Doula who can support and advocate for you through pregnancy and the birth of your baby. I am a mentored Doula for my local area (Lancaster & South Lakes) or you can take a look here to find one in your area:
Take responsibility for your birth – Your body, your baby, your choice!!!
Trust your instincts and listen to your intuition – you’ve got this!!!
*: K. Prusova, L. Churcher, A. Tyler & A. U. Lokugamage (2014) Royal College
of Obstetricians and Gynaecologists guidelines: How evidence-based are they?, Journal of
Obstetrics and Gynaecology, 34:8, 706-711