Tuesday, October 21, 2014

Evidence-Based Care in Birth

On Saturday, October 4th, I attended the annual B.I.R.T.H. Fair. B.I.R.T.H. stands for Bringing Information and Resources to Houston. It lives up to its name because there were tons of vendors, excellent workshops, and even a fashion show. I signed up to volunteer, but there were so many volunteers I wasn't really needed. I decided to just stay and take it all in as a consumer. I'm glad I did!

I didn't take pictures at BIRTH Fair, so enjoy some of my
random baby pictures!
My favorite workshop of the day was entitled "Evidence-Based Care Teaching," which was taught by Dr. Christina Davidson, Dr. Julie McKee, and Sherri Urban, RN. Dr. Davidson is the Chief of OB at Ben Taub Hospital. Dr. McKee is an associate professor in the Department of Family Medicine at UTMB in Galveston. Sherri Urban is a Lactation Consultant at Memorial Hermann The Woodlands Hospital. These women received the Physician and Community Friends Awards this year. 

I wish I could have recorded this workshop because there was so much information that I could not write it all down. I wanted to capture every word. This class made me realize how important it is to take advantage of opportunities to hear leaders in the birth community speak as often as I can. I learned so much!

At the beginning of class, I heard a little bit about how Ben Taub has changed under the direction of Dr. Davidson. I learned that Ben Taub has no nursery, and that all healthy babies stay with their mothers. There is only a NICU for the babies who need that, but for the most part, babies go directly on mom. Also, Dr. Davidson teaches students at Ben Taub certain skills that she called a "dying art" such as VBAC, vaginal twins, and using forceps. She said when she first arrived, there were a lot of practices going on that she referred to as "Ben Taubisms." She would ask the other medical personnel why they were doing certain things, and they didn't have an answer other than "Because that's how we've always done it." They had no idea why they were doing them, even if the practices were good ones. It was just the way it was. 

This story led to a discussion about the differences between evidence-based practices and cultural practices.

What is evidence-based care? 

Evidence-based care is healthcare that includes the following three components: First, one must take into account what the latest reliable scientific research says about a practice. Second, one must consider the experience and knowledge of the care provider. Finally, one must include the knowledge and desires of the patient when practicing evidence-based care. True evidence-based care must include all 3 components in order to be considered evidence-based care. 

Dr. Davidson mentioned that there isn't always evidence to support every practice. This is where care-provider knowledge and expertise and the desires of the patient come into play. She said, "There won't be a random controlled trial on jumping out of an airplane without a parachute, but everyone knows not to do it." Good point.

Baby #1 minutes old-unmedicated hospital birth
After doing some research, a healthcare consumer might find that not all practices are evidence-based. Some of what happens is based on the culture of a certain healthcare facility. Sometimes it takes time for the culture to catch up to the evidence. For example, this explains why ACOG might say that a Trial of Labor for a woman who has had two previous Cesareans is a reasonable option, but there are still VBAC bans in many hospitals. According to Dr. Davidson, "Your practice has to change as the evidence changes." This was a concern of mine as a doula at one point, because I felt bad for sharing information with past clients that has become outdated at this point. My job is to provide information to my clients, so I try to provide the latest evidence-based information. Because I plan to be a doula for many years, I imagine what I tell people will change as the evidence changes. This isn't a bad thing! 

Dr. Davidson went on to say that if someone has been practicing a certain way for a very long time, it might be harder for that person to change. They may not feel comfortable with the new information, which may involve practicing new skills that they don't really have practice with. She mentioned that she has skills in certain areas that she used often when she first started practicing medicine, but because the evidence for it has changed, she doesn't use it anymore. It doesn't matter that she's good at it. The evidence says she no longer needs it. 

Dr. McKee mentioned that once the evidence changes and the culture finally catches up, then things become the "new normal." She began to talk about how a lot of changes are money-driven. "Money is attached to outcomes," she said. She relayed a story about how she got chastened by an L&D nurse for taking the baby from the mother too soon after the birth, which she doesn't ordinarily do. She said she was tickled that the nurse did that because it had become the norm not to take the babies from the mothers. However, it only happened because of a grant they received to work toward becoming a Baby-Friendly Hospital.

Baby #2- home birth
The moderator then asked the panel what they wished that the community knew about the obstacles they faced. Dr. McKee said there are a lot of politics care providers have to face. There is good evidence, but sometimes there is a culture to overcome. I liked what Sherri said about overcoming obstacles. You either have to go around them or go over them. A bridge is a good way to do what. Building bridges is very important. We have to try to build bridges in our community. 

Dr. Davidson said that she wished there was an easier way for consumers to find the right doctor. She would also like to see fewer women needing a VBAC in the first place and more emphasis on "how to prevent the first Cesarean."

Sherri says we need to have more consumer driven healthcare. "You have to care about this." 

One last thought was from Dr. McKee. If there is an opportunity, and you feel comfortable, allow the students and residents to learn from the awesome doctors in the area. If we have the opportunity, we should help future generations of women by helping train the new generations of doctors on how to perform these skills that are considered a "dying art." We need to have a birth Renaissance! 

In order to have a re-birth of evidence-based care practices in this area, it will take all of us as the consumers to do it. There won't be change unless we demand it.