We hear the phrase “evidence-based care” a lot these days when people are talking about healthcare and, in particular, maternity care. Why is it so important?
The benefit of evidence-based care is that we can look at all of the high quality, unbiased best research available based on large populations over time, and draw conclusions about which treatments work, which ones don’t, which ones cause more harm than good and also identify what areas of healthcare need more study for example.
When we make decisions about our care based on evidence, it means we are informed and aware of the benefits and risks of our choices. For example, looking specifically at maternity care, the evidence tells us that continuous monitoring in labour – that is, the use of a CTG* or a trace – is associated with a significant increase in Caesarean section and instrumental vaginal births. So an informed choice might be that you would use this information to look at other safe methods of monitoring during labour such as intermittent monitoring, where your midwife uses a Doppler – that handheld device that sounds like galloping horses – to listen in to how your baby is doing.
In Ireland, we have very few clinical guidelines that examine the evidence base available and make recommendations on a national standardised level of care. There are a small number on obstetric and gynaecological care available here on the HSE website. In the UK however, the NICE guidelines are a comprehensive set of evidence-based guidelines used to inform all clinical care across the UK and are considered the gold standard of evidence-based recommendations. When you are thinking about your own care during pregnancy and the kind of birth that you would like to have, the NICE guidelines on intrapartum care are an excellent place to start in terms of what care would be best for you and your baby.
The important thing to note about guidelines however, it that they are just that – guidelines. They are not policies and can’t be enforced. However a good practitioner will always look to the evidence in terms of making recommendations on care to their patients and clients. And sometimes too, maybe we don’t want to go with the evidence.
What I mean by that is sometimes, after we’ve done all of our research and we’re aware of the evidence-based best practice recommendations, and we’ve put together our birth preferences, maybe on the day our gut is telling us something else.
How do we make an informed decision?
One really important tool to have in your back pocket to help you make decisions – particularly when you’re in labour and you’re having a conversation with your doctor or midwife about how things are going – is BRAIN.
B – Benefits – what are the benefits of what is being suggested?
R – Risks – are they any risks associated with what is being suggested?
A – Alternatives – are there any alternatives and what might they be?
I – Intuition – what is your gut telling you?
N – Nothing – what if we do nothing and carry on with how things are at the moment?
If you need more information to make a decision, ask your caregiver the above 5 questions. Then you should have all the information you need to make an informed decision.
I just wanted to go back to the I there for a moment. When all of the information is laid out in front of you and you feel like you have everything you need with no unanswered questions, don’t underestimate the power of your own intuition, and what your gut is saying, to help you make a decision. Just because the evidence says “x”, doesn’t mean you’re obliged to go down that path simply because you’ve read, understood it and are aware of the pros and cons. An informed decision is one where you’ve taken on board the evidence and are using that information to marry it up with your own perspective, feelings and gut instinct.
On the day you may decide the evidence based option is the one for you, or you might hear your gut tell you that something just doesn’t sit right. Either way, based on all of the information available to you, you’re going to make the best decision for you and your baby. Trust yourself!
Learn more about evidence-based international best practice in maternity care and decision making tools at a GentleBirth workshop at AlphaBirth. Click here for upcoming dates.
© Sylda Dwyer, AlphaBirth 2015. Unauthorised use and/or duplication of this material without express and written permission from the owner is strictly prohibited.