Evidence-based care means care that is first based on the highest-quality, most current scientific evidence, and is tailored to the individual needs of the patient. As simple of a concept as that may be, most people are surprised to find that this model is not in practice in much of American childbirth.
Research shows that some of the most common practices in U.S. hospitals are contrary to what evidence shows is best—and most women experience care that actually increases the chances that they or their babies will be injured or develop complications.
A better question might be: what is not evidence-based maternity care? If our care is not based on science, what is it based on?
Unfortunately, American maternity care is driven by several factors other than what is best for moms and babies. Perhaps the most surprising one is tradition: healthcare, and especially maternity care, is extremely slow to change. Some common practices today—separating newborns from their mothers at birth, having women push on their backs, putting labor on strict timelines—are rooted in protocols and beliefs from the 1940s and 1950s that have long been debunked by science.
Institutional care is also shaped by profit and liability concerns. The fact is that birth is not “efficient,” nor is it predictable. Policies and protocols that try to make it that can conflict with the needs of women giving birth. For example, controlling the speed of labor with medication can be an appealing option for care providers whose time is limited, but it can be much more painful for women and can cause complications like fetal distress and hyperstimulation of the uterus. Almost half of women in the U.S. receive medications to speed up their labor.
Other simple “best practices” are continuous one-to-one support, which we know decreases the chances of C-section and NICU admission, and the use of handheld dopplers to periodically check on babies’ heart tones. Many facilities use electronic monitoring belted to the mother’s abdomen in place of handheld devices and one-to-one staffing, resulting in more complications—including C-sections—to mothers and their babies.