Being Honest about Evidence Based Care
The next piece of hypocrisy for me to tackle is the idea that my style of care is more evidence based than someone else’s idea of evidence based.
I love the natural birth community for many things, evidence based care is not one of them. Much of what my community supports for birth is good, best quality care based on evidence. But often, with the next breath, I hear suggestions not based on evidence but on faith in natural health care.
Some of this is not necessarily bad. The way we learn is to try new things – things not yet supported by evidence. Then if the things work we get more evidence and can make quality decisions based on that evidence. This is how a knowledge base grows, and I’m sure there is some percentage of disagreement that marks a healthy, growing knowledge base.
But at the same time, I need to accept that going natural rouge is as bad and potentially unhealthy as going medical rouge. Most everyone I know in the natural birth community believes it is not OK for a physician to decide that even though evidence doesn’t support use of cesarean for a particular problem, in this case she thinks it is the best way to go. Yet this same community accepts midwives recommending a particular herb, homeopathy or other complementary treatment, without anything more than the recommendation of another midwife.
I understand the concern that there is little research done on certain treatments, but I do not accept the idea that a midwife would begin using something without researching it. The problem lies in the fact that without adequate controls, you can draw the wrong conclusion. Think of all the physicians who used to believe an episiotomy was necessary, or that it was beneficial. The are still places in the world where episiotomy is taught from midwife to midwife and the belief that it works and is important is passed from midwife to midwife. Yet we know from research the place for episiotomy in best practice is very small.
The same thing can happen with any treatment because without the control you cannot tell the difference between how often the problem is resolved without the treatment and how often it is resolved with the treatment. The reality is, a treatment that is no better at resolving a problem than doing nothing is a waste of a family’s time and money.
So, in an effort to ensure the information I share is evidence based, I will be spending this summer updating the website to include evidence. Where evidence is lacking, I will be honest with my readers.