I’ve been wanting to write about evidence based medicine for a few weeks.  I admit to enjoying research and that I like knowing what is likely to happen when I suggest a particular treatment with a client. Evidence helps me make better clinical decisions.  Evidence helps me work more effectively with my clients.

What strikes me as most interesting is how easy it is to fault others for lack of evidence for the decisions they make without providing adequate evidence for one’s own suggested treatment.  Birth professionals on both sides of the natural birth fence are at risk of making decisions not because of overwhelming research, but because “this is what I learned and so this is always right”. I am not immune. Even with my love of research and my constant quest for more knowledge I still find myself sometimes fighting for what I want to be the truth rather than what evidence really says.

With that confession, I wanted to share a very funny piece of satire about evidence based practice. Enjoy!

I’ve one final to go before I’m free from the required studying (at least for a few weeks).  I say required studying because during the break I will still study – I will just have control over what I study.  For me it will consist of reviewing all the midwifery materials from the previous semester and a texbook exploring the research on a variety of complementary and alternative therapies.

And then I started wondering about you, my readers.  What would you be choosing to study during the “break?” Did you even realize that you can do evidence based research on your own?  I propose that you take the next few days to complete this little assignment, and let me know what you learn.

Step One:  Pick an article that discusses new scientific information that interests you.  You might find this in a blog, as part of a news article or even from a tweet or facebook post.

Step Two:  Read the article, making a list of the points the article attributes to the research being discussed.  Make a second list of what the “research” is or who did it.

Step Three:  Find the original piece of research the article was referencing.  You may need to search for the title of the report, study or thesis in Pub Med.  Google can give you some information.  For some publications, you may only have access to an abstract.  Don’t forget you can check your local library to see if they give access to online journals.  A local university may have print copies of a journal you can review.

Step Four:  Read the study (or abstract if that is all you can find).  Pay special attention to the results and the conclusions.  Do the conclusions make sense based on the study question and the results?

Step Five: Compare the study (or abstract) to the original article you found. Did the article accurately represent the research?  Did the article make legitimate assumptions from the research?

OK, go have fun. And don’t forget to let me know what you learn.

One of the first prenatal questions to face a woman, when was the first day of your last menstrual period. This is asked to help estimate the date of birth.

Sigh…I received my own personal gestational wheel in class last week.  The lovely plastic double disks are a gift from Bayer Pharmaceuticals advertising a type of intra-uterine contraception I will no doubt be learning how to administer in a few weeks. Thanks Bayer, because why should I take 20 seconds to do the math in my head (add 7 days, subtract 3 months) when I can spend 10 digging your disk out of my pocket, 20 fiddling to get the dial lined up and another 15 counting the little lines to be sure I have the right date.

OK, so I’m not usually so cynical.  And the markings for specific weeks that include the estimated weight and crown to rump length are actually pretty cool – something fun to share with families that I won’t be able to quickly do math for in my head.  Even hormonal contraception you don’t have to think about every day could be perfect for some families I will work with.  It’s just that arrow pointing to the “Probable Date of Delivery” that makes me roll my eyes (yes, there is an arrow at 40 weeks, but in fairness there is a double ended arrow that sweeps from 38 to 42 weeks).

So why am I so annoyed?  I just read an article about recent research linking birth past 42 weeks with increased rates of cerebral palsy. With so many other reasons (legitimate and otherwise) doctors give for wanting to induce, I hate the idea that they might have one more.

But there is a silver lining here, and that is the risks for cerebral palsy are about the same or higher in weeks 37 and 38 when compared to weeks 42 and after.  Armed with this information, families may feel more confident in their refusal of early induction.

If you are reading the article, please don’t freak out. 40% does not mean that 40% of babies born 42 weeks and after will have cerebral palsy.  40% is the amount of increased risk – in other words the relative risk increases 40% not the total number of cases.