Every day I see women bemoaning the fact that they can’t access evidence based care. They are being denied the option of vbac, being induced early for well controlled GD, being given stretch and sweeps at 38 weeks, routine VEs during labour and the list goes on. As a birthworker I find it distressing and frustrating and as a woman planning more births in future it scares me.
As intelligent women and caring mothers we want to receive evidence based care for ourselves and our families. We deserve all the facts in relation to all our possible options.
We'll tell you what we want...what we really really really want! Image courtesy of Wikimedia commons.
So in a modern, secular society like ours – why can’t women access evidence based care?
And is it really the BEST possible option?
The problem with evidence based care is that it can be confronting. We have been conditioned to believe a lot of things about pregnancy and birth that aren’t necessarily evidence based. And questioning our cultural conditioning can be hard. Never mind the fact that we often learn that decisions that we have made in the past were NOT evidence based and can be left with a lot of guilt, which can make us very defensive.
When we start to hear about evidence based care some questions may come up: Why wasn’t I told? Does that mean I made a “bad” choice? What if the “evidence” doesn’t fit with my own understanding of pregnancy, birth and how the world works? What about all that anecdotal evidence?
So let’s really lay it out in black and white:
Most women don’t actually want evidence based care.
Yes we do! I hear you yelling. Evidence based care is the gold standard and we want the gold standard. We DESERVE the gold standard. And in Jerry Maguire fashion I see you yelling: SHOW ME THE EVIDENCE!!!
But here’s what we want…what we really really really want (Oh no…two 90’s pop culture references in one blog, I’ve obviously had too much coffee today!). We want:
Care based on our own individual beliefs, values, cultural conditioning and circumstances. We want to see the evidence, discuss and interpret the evidence and then receive care based on all the above AND our interpretation of the evidence.
Women don't deserve evidence based care and the limits that it imposes on us. We do deserve care based on our own beliefs, values, cultural conditioning and circumstances. Because those are all the factors that go into making a decision. We don’t make decisions in a vacuum. I don’t know anyone who makes their decision on statistical evidence alone. Feel free to leave me a comment if you do.
That’s why 20 people can read the same research and make totally different decisions based on it. It’s why some women read that they have a 1/200 chance of uterine rupture and freak out, while others go “wow – so I have a 199/200 chance of everything being totally fine. Sounds awesome!”
There’s also a phenomenon in research called “confirmation bias” and we see it a lot in maternity care. If I am pregnant with twins and want a vaginal birth then I will seek out “evidence” that vaginal birth for twins is a very safe option. If my OB wants me to be induced at 42 weeks then the information that he gives me will likely show that induction at 42 weeks is safer than waiting. This isn’t anything terribly controversial – it’s just human nature.
So the next time you are demanding “evidence based care” remember: Evidence still needs to be interpreted. By a human. Who has probably had a range of human experiences that will colour how they interpret the data and the recommendations. Then ask who you want doing that interpreting – someone who’s life ISN’T on the line? Someone who has had very different experiences to you? Someone who has different cultural beliefs and values?
Individualised care? Sounds revolutionary! Image courtesy of Wikimedia Commons.
Or do you want the evidence to be interpreted by YOU.
So instead of evidence based care let’s start demanding: Individualised care. Care for me, based on me.
Just remember that we're not ignoring the evidence - just allowing the interpretation to be done by the one affected by the decision. This is evidence based care taken to a whole new level.