“Evidence-based care”

I think that it is no secret that I tend to lean toward the more natural side of birth when it comes to interventions (although I strongly believe that a woman should be given all the information then make up her own mind).  I’m in the middle of reading book upon book for my doula certification – many of which I have read before and several new to me.  These books – hand-picked by DONA and Seattle Midwifery School are wonderful and I wish they were more the norm of what pregnant women educated themselves with instead of “What to Expect” et. al.

However.  I must wonder, in the middle of my holier-than-thou complex, what student OBs and L&D nurses read?  Aren’t their text equally as compelling and surely laced with studies and anecdotal evidence that “prove” the need for our current, high cesarean rate and all of our interventions?  (Or is it that OBs are just so busy they don’t have the time to read the latest study that disproves what they where originally taught in medical school?  Or maybe it is more about the fear of a lawsuit that could take them out of business so they do what the courts would see as the safest way to proceed – to do something – instead of do what we as natural birth advocates are taught is safer – to do less?)

Whatever the case, I don’t want to be so concieted as to think that what I am being taught is the be-all and end-all of “evidence-based care”.  There must be evidence on the other side or doctors wouldn’t be going down that path. I don’t think OBs are evil – in fact I am sure that they have the best interests of their patients in mind but they are being taught from an entirely different angle.  Why is this?  Is one side more “right” than the other?  I couldn’t say since I haven’t been equally balanced myself.

I need to get my hands on a copy of  Williams Obstetrics.

Better yet, I’d love to see a book written that compares each school of thought without any prior prejudices – or at least balanced prejudices.  Perhaps co-authored by a midwife and an OB?  To my knowledge there are no books like this on the market.


4 Responses to ““Evidence-based care””

  1. 1 Dan June 19, 2007 at 11:26 am

    I would doubt there is a book like that. There certainly isn’t with psychiatry that I know of.

  2. 2 Kaitlin June 19, 2007 at 11:00 pm

    I could probably write for pages about this topic! 😉 But I’ll try to spare you a lengthy comment…

    I’m sure that the “traditional” obstetrics texts are just that–extremely traditional. Keep in mind that medical students really don’t learn very much about any one type of medical practice during medical school–we’re thrown some basic material on the physiology and pathology of childbirth during years 1 & 2, and, at best, we’re required to do a 4 week rotation in obstetrics & gynecology during years 3 & 4. Some students do more than this–but some only get the bare minimum. Judging from how informed you are, I’d bet you probably know how to deliver a baby better than most med school graduates when they’re handed their diplomas!

    Unfortunately, physicians who choose to do a residency (the part of medical training where one really learns how to be a doctor and not just the theory behind the practice) in obstetrics and gynecology are, truly, *surgeons* at heart. The majority of their training is spent in the OR. As a result, most OB/GYNs, IMHO, are not trained to “be” with a woman during childbirth. They’re present for the birth itself, know how to manage emergencies, and they know how to cut. The training isn’t better or worse–it’s just surgical. And seeing birth as surgical is largely antithetical to what midwives or doulas or practitioners who are “with” women during birth believe/witness/practice.

    That said, I did find some interesting information that you might like. We were (finally?!?) assigned a textbook on “Integrative Medicine,” one of the editors/writers of which is Andrew Weil, MD. The text is evidence-based and includes full references to peer-reviewed journal articles for each chapter. It has 4 chapters that deal with different aspects of pregnancy, including a rather interesting one on labor pain management. From what I’ve read thus far, the book seems to do a good job of acknowledging a wide range of treatments no matter from which “side” of medicine they arose, and offers evidence on each. The book is titled “Integrative Medicine,” by David Rakel, MD, and is in the 2nd edition, published this year (with the prior published in ’03). Its ISBN # is 1-4150-2954-0 and it costs about $100 on Amazon, I think.

    I guess this is all to say that there is integrated information out there–it just takes some digging to get to it. Also, many medical schools (like mine) are just now adding such information to their curricula, so don’t be surprised if even recent medical grads are unaware that such books exist. I hope this helps! Feel free to email me if you have any questions.

    Also, a request: could you please publish the list of books you’re reading on your site? I think many readers would benefit from having a list of books on pregnancy to read that are outside the “What to expect…” box. If you have time/are willing to also provide reviews as you read, that would be fantastic, too. Thanks! 🙂

  3. 3 Agatha June 19, 2007 at 11:05 pm

    Hmmmm… Can you list more of the books you’re reading? I’d love to have a look at some Doula books!

    Right now I am reading ‘Myles Midwifery’ – the Midwifery Bible in the UK. There is also ‘Mayes Midwifery’, but it’s more picture-based, less factual.

    Last night I read ‘The Mother-Midwife Relationship’ by Mavis Kirkham in one sitting. Kirkham is perhaps one of the most respected midwives in the world & this text is outstanding. Her research is thorough, compelling & her conclusions are, of course, evidence-based. Her contemporaries are Ina May Gaskin, Caroline Flint, Mary Cronk etc.

    Have you read Spiritual Midwifery? I’m thinking you have, Gaskins stats are compelling & frightening – maybe one day her mode of care will be standard. I doubt it though.

  4. 4 Rachel July 3, 2007 at 6:19 am

    Also keep in mind that textbooks are not really a first-line source for evidence-based medicine. New research is constantly being published, and when our docs have a question about the evidence, they want studies appearing in peer-reviewed journals; the textbooks are more for general learning/reference. Shoot me an email if you’d like me to send you some PubMed search strategies for finding articles on the topics you’re interested in (I’m a medical librarian).

    I just peeked at Williams, and it does list rising rates of labor induction as contributing to the high c rate, as well as liability concerns (along with other issues such as breech and maternal age). The breech management section also talks about methods of vaginal delivery. It also says it’s difficult at this time to justify maternal-choice c-section, so it may be more critical than you expect.

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