Gone are the days when you walk into a hospital for any medical procedure and simply trust that the medical team will do what is in your best interest. We are in a time that not only is patient advocacy crucial, but patients have the right to demand that care providers follow procedures that align with evidence-based care. Mothers preparing for birth should expect no less from their obstetric care providers.
For example, if the medical research shows that episiotomies are not recommended for routine use, then the care provider should not be performing them except in rare circumstances.
According to a recent article in the American Journal of Obstetrics and Gynecology several management decisions were reviewed in the medical literature. Review included the use of recognized online medical search engines such as PubMed and the Cochrane Review Library. In the review, the researchers came up with their list of “recommended” management, defined as “good quality” care as well as the list of decisions that either could increase complications or do not have any measurable benefit. Some of these management decisions are described below.
Evidence-Based Good Quality Care
- Hospital Births– According to their research hospitals won out over other birth settings such as homebirths or birthing centers. While some experts would argue that out-of-hospital births would decrease the routine interventions used as well as the risk of cesarean, this review board believes that the benefits of a hospital setting outweigh the disadvantages.
- Delayed Admission– Admitting women until their labor is well-established, rather than admitting them in early labor, has proven medical benefits and a reduced chance of interventions such as pitocin and cesarean birth.
- Support by Doula– Research overwhelmingly indicates that the benefits to mother and baby are numerous with labor support by a doula, including fewer medical interventions and cesareans.
- Trained Birth Assistants in Developing Countries – This idea could include training lay people or family to support mothers during labor.
- Upright Position in Second Stage – Likely this could be one of the most difficult health care issues to change since most providers still insist in delivering babies when mother is on her back in stirrups, rather than in a upright position during second stage.
Evidence-Based Care that Should be Avoided
- Enema – While routine practice at one time, enemas can cause intestinal cramping and may be unnecessary.
- Shaving – Another routine practice that was done to reduce infection; however research shows that the tiny cuts caused by shaving lead to more infection.
- Routine Vaginal Irrigation– Otherwise known as “douching”, this technique has not been shown to be helpful, but instead vaginal irrigation disturbs the normal vaginal bacteria and self-cleaning of the vagina and can lead to more infection.
- Early Amniotomy – Research shows that early amniotomy or “breaking the mother’s water” early in labor does not speed the progress of labor. Early amniotomy may also lead to an increase in infection and cesareans.
- Episiotomy– All of the research conducted in the last 20-30 years has shown that episiotomies can increase the level of postpartum pain, increase the length of the mother’s recovery time, and might increase the likelihood of deeper tears. In general, episiotomies can cause more harm than they do benefit.
As you interview your own care provider and place of birth, be sure to ask for these “good quality care options” and to discuss the care practices that should be avoided as early as possible in your pregnancy.