Before even getting pregnant, I watched the documentary The Business of Being Born, which explores the experience of childbirth in the U.S. today. While I recognize the film’s biases, it was enlightening for me. For the first time, I saw that childbirth didn’t have to happen as it’s depicted in the media—a woman lying on her back in the hospital, screaming for drugs, a nurse by her side telling her how to breathe. It could be an empowering experience, and one that reflects just how miraculous birth is.
When I became pregnant, I wanted to do everything I could to have a positive birth experience. I hired a doula, attended prenatal groups with the doulas, and, instead of taking classes at the hospital, attended an evidence-based birth class. In the class, I learned about how many standard policies surrounding birth are not supported by current research, and aren’t always best for mom or baby.
That’s what evidence-based maternity care and birth is all about—care that is based on proven scientific evidence from high-quality medical research. And it’s not the norm in the U.S.
In fact, says Julie Le of Mama Fox Doula, an Austin-based doula and an Evidence Based Birth® instructor, “in maternity care, it takes 17 years from whenever the research is released to when it’s actually put into practice.” So you can’t count on your doctor or hospital providing care that aligns with the most current evidence.
A typical birth in the U.S. often includes using IVs, continuous electronic fetal monitoring, not allowing women to eat or drink during labor, restricting movement during labor, and having mothers push on their backs. These practices are not supported by the best available research, and can actually increase stress for mom and baby and interfere with the natural process of labor.
Labor inductions are also done for reasons that aren’t evidence-based sometimes, like convenience or a suspected large baby (providers are wrong about half the time when predicting a big baby). Inducing labor can lead to further interventions and side effects that carry risks and may not be preferred by the birthing person, like epidurals and cesarean sections.
Cesarean sections are another important issue in evidence-based maternity care. Though they are necessary and life-saving at times, they are performed far too often in the U.S. From 1990 to 2017 the rate of cesarean delivery increased from 23 to 32 percent, meaning almost a third of all women giving birth end up having one. That’s an alarming rate considering the serious risks associated with cesarean deliveries for both moms and babies, and indicates that women may not be receiving optimal care during birth.
So why are these practices so common if they aren’t evidence-based?
For one, says Le, doctors “tend to work based off the way they were taught,” and it’s easier to continue with tradition than to change. Another reason is that many common interventions, like induction and cesarean sections, benefit hospitals financially, so there is an incentive to use them, even if there’s not an evidence-based reason to do so. Doctors also worry a lot about being sued, and this pressure may cause them to lean on practices that are not evidence-based but are seen as less of a malpractice risk.
There’s a convenience factor too: scheduled induction and cesarean deliveries can help hospitals plan for nurse staffing, and help providers avoid working on holidays. Getting women in and out of delivery rooms more quickly can reduce staff time as well. While those policies might make the hospital more efficient, it may come at the expense of providing evidence-based, individualized care.
Yet another barrier to evidence-based care is that most women who give birth are healthy and low-risk, but they aren’t treated that way because doctors are trained to handle higher-risk pregnancies. This has made birth an increasingly medical, intervention-heavy experience that is seen as a time when things are likely to wrong, rather than a normal physiological process. Our bodies know what to do, but most of the time we aren’t trusted to do it.
Faced with all these barriers to evidence-based care, it’s on us as women to educate ourselves on the current research and figure out all our options when it comes to birth.
Then we can advocate for ourselves and try to have the kind of birth we want—medicated, unmedicated, at a hospital or a birth center, at home, etc.
Stephanie Spitzer-Hanks of revdoula, a Waco-based doula and an Evidence Based Birth® instructor, says that “something that’s missing from a lot of childbirth education is understanding how to advocate for yourself, and knowing that as a patient you have rights, and you can negotiate.” Hiring a doula can give you additional support, resources, and knowledge so that you can better advocate for yourself as a patient.
It’s also important to talk to your provider and find out if they’re a good fit for your values and preferences. Le recommends asking your provider about their statistics, like their cesarean birth rate, as well as what they think the benefits, risks, and alternatives are for different procedures.
“If you have a provider that in your gut is making you feel like you shouldn’t be asking these questions,” she says, “then give yourself permission to change providers.” The relationship between you and your provider should ideally be a collaboration where your values and preferences are heard.
No matter how you view birth or what kind of birth you want, it will undoubtedly be a day that you remember forever.
But to have any control over what that experience will be, you have to arm yourself with knowledge and be willing to speak up, ask questions, and make decisions for yourself. It’s the beginning of your life-changing journey of parenthood, and you deserve for it to be a positive experience, not something that just happened to you.
Spitzer-Hanks gives the final rallying cry: “Birth is such an important day, and it makes an indelible print on your psyche. It’s worth investing in, and not blowing it off or giving all your power to somebody else. I want women to claim their own power, that’s all I want. Because we’re so powerful…we’re amazing.”
Evidence Based Birth®
The Birth Hour (offers an online evidence-based birth course)
Connecting the Dots – Lamaze International blog
Our Bodies Ourselves
World Health Organization
Labor and Pregnancy Support
Central Texas Doula Association
Find a doula and learn more about doulas through their DoulaShare and Keep Austin Doula’d events
Giving Austin Labor Support
Provides free labor support for all income levels, and free prenatal care for low-income families
Mama Sana Vibrant Woman
Provides free pregnancy, birth and postpartum support for black and Latina women in Austin
Pregnancy and Postpartum Health Alliance of Texas
Provides low-income women who are experiencing a perinatal mood disorder with 20 hours of free in-home care with a postpartum doula