I was introduced to a series of essays you should read. They highlight the struggles inherent in science, and how those struggles result in a lack of evidence for doula care. Head on over to Doulaing the Doula for this four-part essay (as of today it appears only 3 of the 4 parts are published). While you are there, consider how these same issues result in the lack of evidence for other ways to promote physiologic birth as well.
So, why is this important?
You may not feel like it is true, but most health care providers and most hospitals try to provide evidence based care. It is true that they have varying levels of success and that many factors contribute to the varying levels of success. Yet we cannot ignore the fact that one of the reasons it can be difficult to get a facility to adopt something we “know” will help promote physiologic birth is because there is an evidence gap.
For example, my team recently completed a massive literature search about hydrotherapy in labor. We found the scientific literature did not have the evidence we needed to write a hospital policy. We knew the big outcomes, but translation of the “big outcomes” to a hospital program takes a completely different set of studies. The studies needed to write hospital protocol do the work of teasing out which eligibility criteria and which practices to ensure safety are necessary. Right now we seem to be at the level of, “this is the way they do it at hospital X so we’ll just do it that way here.” That’s not the quality of evidence we need and it doesn’t result in evidence based policy. Unfortunately, that makes it easier for hospital staff (who are already over worked) to justify putting their efforts and resources elsewhere.
We are also missing the economic evidence we need to justify the use of hydrotherapy in labor. Hospitals in the United States make decisions about what services are best investments. Without economic evidence it can be almost impossible for nurses to convince administration that installation of tubs is a good investment.
Friends, this particular struggle is just about using warm water for comfort — something we all take for granted at home. Imagine then how much more difficult it is to institute something actually new, like a doula program.