So, Who Are We?
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The mission of the Triangle Birth Network is to advocate for “evidence-based” maternity care. So, what does that mean? What is evidence-based care, and how is it different from the care many women receive during their pregnancies and births?
Evidence-based medicine (or EBM) means that care providers integrate their clinical expertise and individual patients’ needs with the latest scientific evidence about which medical interventions are likely to be helpful, and which are not. This means that practitioners must stay well informed about the latest studies and systematic reviews—a difficult task in the time crunch of modern medicine—and consider altering their care practices (based on an individual patient’s situation) when a particular intervention has been strongly shown to be helpful or harmful. The Cochrane Library is one important resource that practitioners and the public can use to keep apprised of the latest studies.
Another important resource for evidence-based decision-making in maternity care is the Guide to Effective Care in Pregnancy and Childbirth1. (You can read this Guide online at Childbirth Connection.) The Guide classifies common medical interventions according to six categories:
- Beneficial forms of care,
- Forms of care that are likely to be beneficial,
- Forms of care with a trade-off between beneficial and adverse affects,
- Forms of care of unknown effectiveness,
- Forms of care that are unlikely to be beneficial, and
- Forms of care that are likely to be ineffective or harmful.
In other words, medical interventions are classified along a spectrum of those interventions we know to be helpful to those we strongly suspect are harmful, based on a comprehensive review of all available scientific evidence. Ratings are made very conservatively, and very few interventions receive the highest or lowest rating—so when they do, mothers and care providers should take notice!
This very important resource has the power to reshape maternity care today. But only if we—both mothers and care providers—pay attention to what the best scientific evidence shows, and demand that routines and protocols change accordingly. In fact, one of the most ubiquitous images of birth in our time—that of a mother lying on her back with her legs in the air while enthusiastic care providers admonish her to “PUSH!”—is associated with one of the few care practices that received the Guide’s lowest rating. “Routine use of the lithotomy position for the second stage of labor,” or pushing while on your back with your legs up and pulled back, has been shown by many rigorous scientific studies to do more harm than good. And yet—in thousands of hospitals around the country right at this minute, women are giving birth in this position!
The Triangle Birth Network, along with the Coalition to Improve Maternity Services and other grass-roots organizations around the country and globe, want this to change. We hope that all women will become informed about what the evidence says about the maternity care they receive, and that their care providers and birth places will be open to considering this evidence and changing their practices accordingly.
1. Murray Enkin, Marc J.N.C. Keirse, James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr, Guide to Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press, 2000.