Comfort Measures in Labor: Evidence-Based Medicine
This may seem like a strange topic for “Comfort Measures in Labor” but I do believe that a physician/midwife and/or hospital/birth center that practices evidence-based medicine (EBM) can bring great comfort to the laboring mother.
As a note, there are many times I use the phrase “physician” in this post but in most occurrences the same can also apply to midwives.
What is evidence-based medicine?What is evidence-based medicine? Click To Tweet
According this publication:
“Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information. It is a movement which aims to increase the use of high quality clinical research in clinical decision making. EBM requires new skills of the clinician, including efficient literature-searching, and the application of formal rules of evidence in evaluating the clinical literature. The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning in which caring for one’s own patients creates the need for clinically important information about diagnosis, prognosis, therapy and other clinical and health care issues.” (NCBI)
So, what exactly does that say in layman’s terms?
Essentially, EBM is a conscientious effort to practice medicine based on modern research. It also considers the evidence as tailored to a specific patient. For example, if a physician is considering the treatment of a female patient, he may ignore much research that was performed specifically or mainly on male patients. This medical practice considers the patient’s wishes and values as well as the physician’s clinical experience.
Traditional medicine has taken into account clinical studies and evidence but often gives great weight to tradition and “this is how we have always done it” or “this is the policy.” While tradition may be good and having policies is necessary to practice good medicine, we should always question if the tradition or policy is the best practice for each patient. EBM calls for better evidence than what traditionally has been accepted.
“One of the greatest achievements of evidence-based medicine has been the development of systematic reviews and meta-analyses, methods by which researchers identify multiple studies on a topic, separate the best ones and then critically analyze them to come up with a summary of the best available evidence.” (NCBI)
Good evidence-based medicine is reliant on everyone involved. It requires the physician to study and critically evaluate current clinical literature, the hospital must be willing to change policies based on the evidence and willing to try new techniques, and the patient must be open to trying new techniques and be the voice to encourage the physicians and hospitals to practice EBM. The desire is to increase the quality of care and eliminate practices that offer no benefit. Due to constant changes in technology, clinical experience, and evolution of diseases, there is not end to EBM. As the quote above states, EBM is a lifelong study.
“Medical knowledge grows every day, so that previously accepted facts rapidly become old and it seems impossible to follow such explosion of scientific information. There are clear difficulties when clinician needs to keep step with the new achievements published in medical journals: for example, general practitioner should read 19 articles every day, and we know that many of them have only one hour per week for this. The problem of academic isolation or armchair phenomenon occurs, where the doctor should spend most of its work hours only to review all published articles and studies. On the other side, even if the doctors find the time to read all of them, they would be lack the time to evaluate the value of the study, its methodology, outcome and transparency. That is why a need occurs that the doctor, with his limited time, read selectively, make effective selection of what he reads, and what not.” (NCBI)
The demand for physician’s time grows more and more every day. We expect them to have all the answers and become upset when they don’t or may not know some practice that we have heard about. Media portrays the life of a physician as glamorous at times but in reality, most physicians and midwives are overworked and under-appreciated. When most of us leave our jobs, we enjoy time with friends and family and relaxing. When a physician or midwife goes home for the day, many nights and weekends they are on call which means they never can fully relax. As with teachers taking home papers to grade, physicians and midwives often go home to spend their evenings reading the most current medical breakthroughs and clinical advancements. While, yes, that is part of what they signed on for, it isn’t an easy life and can be quite exhausting. We need to have grace for our healthcare workers.
Rather than always expecting out healthcare team to know all the latest research, it may be more helpful to approach your physician or midwife with evidence-based medicine research and ask him/her to take a look at it and get back ot you as to whether it may be something appropriate for your care.
We should also always take into consideration the clinical experience of our healthcare team. There may be some new and exciting procedure that can be beneficial in your situation but if the physician is not trained properly or if the hospital does not have the tools to perform the task, it may be more dangerous than sticking to what the physician and hospital are equipped to handle. A physician or hospital may also have their hands tied in certain areas based on a locations laws whether state or federal. Some medical practices must pass years of testing before it can be presented to the general public. In these cases, we must be patient with the process and encouraging to others who are waiting with you.
How is evidence-based medicine comforting to the woman in labor?How is evidence-based medicine comforting to the woman in labor? Click To Tweet
Some women do not care. They trust their doctors and hospitals and are perfectly comfortable letting them make most of the decisions. This is how some women find comfort and that is just fine. For others, however, not knowing what her options are, not being aware of everything going on, and not feeling like she is the one in control of her healthcare can cause her greater anxiety and fear.
Even in situations where the healthcare team must make instant decisions and may not be able to inform a mother exactly what is happening or let her have the time to make a choice, knowing that her physician/midwife and hospital/birth center are making decisions based on evidence-based medicine can help her to have peace.
Being able to trust your caregivers and birth location goes a long way in relieving anxiety surrounding your birth. The more relaxed and at peace you are in your situation, the more likely you will look back on your birth experience positively.Being able to trust your caregivers and birth location goes a long way in relieving anxiety… Click To Tweet