Are Common Hospital Childbirth and Breastfeeding Practices Based on Research Evidence?

Note:  To go directly to the Evidence Based Birth website, click here

If you have been around for a few decades, as I have, you have probably heard the "Ham Recipe" story.  It goes like this (borrowed from http://able2know.org/topic/4965-1, and revised a little):

The family was gathered for a special dinner. The youngest newly married daughter was preparing her first family dinner. As she was about to put the large ham in the oven to begin baking, her mother stopped her and said "You have to cut three inches off the ham before you bake it." Puzzled, the daughter asked her mother why? "Because that's the way my mother taught me to do it," said the mother. Still puzzled, the daughter went to find her grandmother.
"Grammy," she asked, "Mom says you have to cut 3 inches off of the ham before putting it in the oven to bake. Why?" "Well, that's how my mother taught me to do it, and it's the way I've always done it," replied the grandmother.
 
The next day, the daughter went to visit her great grandmother, who was in assisted living. 

"GiGi," he asked, "Grandma says you taught her to cut 3 inches off of the ham before putting it in the over. I'm puzzled. Why is that necessary?"
"Well, dear, when I was a new bride, just starting out, I baked my first ham for Easter dinner. The ham was 20 inches long. The largest roasting pan I had was 17 inches long, so I had to cut three inches off of the ham to make it fit the pan."
 
Some medical practices are not entirely unlike this story.  The first research paper I was required to do in my BSN program was to write a paper on Dr. Teresa Christy, a nurse who practiced in the mid-1900s.  She was curious enough to ask "Why".  When she was learning to care for patients who had had pelvic surgery, she was told to NEVER, EVER take a rectal temperature.  When she asked "Why" she was told of the potential for excessive bleeding or damage to the nearby surgical area.  When she did further research, she found that many years earlier, the bulb on thermometers where much, much larger.  They were so large that they could put too much pressure on surgical sites.  But, thermometers had evolved and the bulbs were much smaller and posed no threat to the surgical wound.  Therefore, it was safe to take a rectal temperature, which, in some cases would provide the most accurate reading and possibly catch signs of infection earlier.

That story stuck with me.  As a childbirth educator, I often come across medical practices which have been the standard for a long time.  Some were based on the way things were decades before.  However, evolving medical practices, or better research has shown that those practices are unnecessary.  In some cases, they increase the risk of other problems for the patient. 

It is important to remember that everything in the medical realm has its benefits and its risks . . . and that includes doing nothing.  Health care consumers help themselves when they search out the known benefits and risks of any upcoming procedure.

I recently found a web site which does a superb job in putting forth the evidence on a number of obstetrical and breastfeeding practices common in today's hospital system.  The writer is Rebecca Dekker, PhD, RN, APRN.  She has done an amazing job of studying the research, and answering common questions based on it.  Her material is reviewed by two physicians and a midwife. She updates the site regularly.

I strongly recommend every expectant mother, every obstetrician, every pediatrician, every family practice physician who cares for babies,  every women's health nurse, every childbirth educator, every lactation consultant, every midwife, and anyone else who might be providing education, support, or health care to pregnant women and new mothers to read it.  When health care professionals read it, they will find solid rationale to consider making some changes in their practice -- or least to support their patients who desire to approach labor, birth, and breastfeeding in a way that is different from the providers' typical practice.  Expectant mothers will find solid support for approaches to labor which are based on solid research, but are not necessarily practiced in the hospital setting.

Click on the following link to visit this wonderful site, but come back here to read some additional important information.  Bookmark the site while you are there so you can go back over and over again.

Evidence Based Birth

If you are expecting a baby, please read the various topics.  If you decide, based on the research evidence to incorporate a certain approach to labor into your birth plan, print the handout which relates to that approach.  For example, if you desire to labor without IV fluids, print "IV Fluids in Labor".   

One issue I see coming from this are care providers who say "We practice according to the policies or recommendations of the professional organizations associated with our area of practice."  This does provide some legal protection for the practitioners.  However, all professional organizations do not put forth recommendations based on the entire body of research, or the most up to date research.  The recommendations can be dated, waiting revision.  Sadly, they can be influenced by contributions or remuneration from companies with a vested interest in what those organizations say or do.  

For example, even though the American Academy of Pediatrics strongly supports breast milk as the species appropriate, natural, and best food for babies, it has recently agreed to have it's logo printed on "gift bags" distributed by Mead Johnson, a formula company.  When women see the AAP's logo, it sends them a message that pediatricians approve of that formula over another.  It also sends a message that formula is an approved, healthful baby milk, somewhat in the same league as breast milk.


Women often continue using the same formula they find in the bag their care providers gave them.  Not surprisingly, Mead Johnson, and other companies, put in their more expensive types of formula.  As result, families spend hundreds, and possibly more than a thousand dollars a year on the more expensive formula -- without evidence that it is any better than other types.

So, when a physician, or other health care provider, says he or she bases his or her practice on the recommendations of "this" or "that" professional organization, it does not mean that those recommendations are based on the total of available evidence, or on the latest best studies, or even in the best interest of the health care consumers.

Preparing for childbirth and for breastfeeding in most hospital settings REQUIRES that the mother do her own research.  Yes, she should talk with her care providers.  They will provide information which is helpful.  But, in some cases, that information may not be totally up to date.  One example is basing how well a woman is progressing through labor on "Freidman's Curve", a long outdated graph of what is "normal".  This was plotted in the 1950's when women were sedated and often restrained in the bed and on the delivery table during labor.   The normal time frames for each part of labor is different now, and this can be further affected by how the mother copes with pain (medicate or not), her positions, and so on.

Information from any individual care provider may be partially based on personal experiences or preferences, rather than current research.  Therefore, getting good information from a reputable, objective source gives the mother a better picture of the pros and cons of her choices and options.  

Proverbs 11:14  tells us there is safety in a multitude of counselors.  This website (Evidence Based Birth), in my opinion, falls into the category of a great "counselor."