Another instance in which hospital policy may not match the evidence is with regard to suctioning the baby’s nose and mouth immediately after birth. Some doctors may suction all babies routinely. Others have a policy to only suction if meconium (baby’s first bowel movement) is present.
However, the newest protocols from the American Academy of Pediatrics say not to suction while the baby is on the perineum at all–whether or not meconium is present. A fellow independent childbirth educator, Jeanne Anderson, was certified in neonatal resuscitation by the American Academy of Pediatrics this year and shared the following information about the AAP’s 2007 guidelines:
“Their latest research indicates that the baby will spit up the meconium on its own, and if it is one that will develop respiratory problems, they will happen regardless of perineal suctioning. The newest protocols are to birth the baby and only wipe any visible mucous from the mouth/nose with a towel as you are handing the baby to the mom and
visually evaluating him/her. If the baby needs more resuscitation it will show up as poor respiratory effort, lowered heart rate or poor color, which can then be addressed. Normal infants will only need help less than 10% of the time.”
A woman in labor is working harder and longer than she may ever have done before. Eating is important to maintain her energy, strength, stamina, and good health. Many women choose light, easily digested foods–whatever appeals to them most at the time. However, many hospitals and care providers have a policy in which laboring women can only have ice chips to “eat” during labor. Others permit water and sometimes clear liquids. This is an example of a situation in which common policy and routine is NOT in accordance with evidence based care.
A large recent study from the UK confirms what birth professionals have long felt to be true–that light eating during labor does NOT raise the risk of complications.
Policies denying women solid foods during labor are often explained with the reasoning that there is a risk of “aspiration pneumonia” if you eat during labor (and then end up having a cesarean under general anesthesia). The researcher, Dr. Liu, says that this problem “did not occur.” He also stated that the UK Department of Health’s records show only one case of aspiration in two million births (the risk of complications of cesarean is considerably higher than that and that doesn’t stop US doctors from having a 31% national rate of cesareans!).
Policies against eating during labor originated during the 1950’s and things have changed a good deal since then. As an ICAN representative stated, “This new study will allow doctors to rest assured that eating helps rather than hinders the birth experience.”
The excellent exhaustive research summary and review A Guide to Effective Care in Pregnancy & Childbirth (available for free download from Childbirth Connection), also supports light eating during labor, pointing out that not doing so leads to a risk of dehydration and/or ketosis. Withholding food or drink from women in labor is included in the Effective Care book’s table, “Forms of care unlikely to be beneficial.”
Simply put, evidence based care is care that is based on the best available evidence (research, studies, accurate, up-to-date published materials) and upon the individual woman’s unique situation. Any interventions are applied judiciously and with consideration of true medical indication and also the needs of the woman. Evidence based care is different than “routines” or “policies” which may or may not have a basis in evidence.
Citizens for Midwifery has an excellent fact sheet summarizing the evidence behind the Mother Friendly Childbirth Initiative’s 10 Steps.
In her excellent new book, Pushed, Jennifer Block shares the following about evidence based care:
“…The goal is to have a healthy baby. ‘This phrase is used over and over and over to shut down women’s requests,’ she [Erica Lyon] says. ‘The context needs to be that the goal is a healthy mom. Because mothers never make decisions without thinking about that healthy baby. And to suggest otherwise is insulting and degrading and disrespectful’…What’s best for women is best for babies. and what’s best for women and babies is minimally invasive births that are physically, emotionally, and socially supported. This is not the kind of experience that most women have. In the age of evidence based medicine, women need to know that standard American maternity care is not primarily driven by their health and well-being or by the health and well-being of their babies. Care is constrained and determined by liability and financial considerations, by a provider’s licensing regulations and malpractice insurer. The evidence often has nothing to do with it.” (emphasis mine)
In the next couple of posts I will address some specific examples of evidence based care.