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Doctor Knows Best – Or Thinks He Does

One of the criticisms I’ve had levied against me for choosing homebirths and doing a great deal of the pregnancy research myself is that I’m implying that doctors don’t know what they are doing.

The fact is — I’ve never said that and would never say that. I have said that sometimes the policies of a hospital or particular OB-GYN are NOT based on evidence but usually on just what they’ve been taught.

In a recent review of over 700 practice guidelines by ACOG, it was found that over a third of the “guidelines” were actually based on doctor opinion and bias — not on any scientific research, studies or controlled trials.

Sounds like what many in the childbirth community have been saying for years about such policies like electronic fetal monitoring and episiotomies: that there is no evidence to support their routine use outside of specific, high-risk or unique situations.

“It is disappointing, but I don’t think it reflects their process,” said Auerbach, who was recently part of an Institute of Medicine committee to develop standards for better guidelines. “It is really a call for better evidence.”

Now that’s not to say that OBs are the only ones guilty of this. I know childbirth educators and midwives who have stated that using garlic is an effective treatment for GBS. My midwives actually did experiments testing two people who were positive for GBS, and garlic was completely ineffective in counteracting the GBS. It was interesting to me to find midwives as interested in digging beyond their natural biases to see what really held up.

Until we have nation-wide continuity of care and guidelines and practices we can TRUST, I am grateful that anyone with a laptop, a library and half a brain can access studies, health journals, etc for themselves and determine what birth practices they feel comfortable with. Hopefully we’ll see an increasing number of doctors who embrace the well-educated patients as partners in personalized health care, instead of as a threat to their authority or “kooks” or “whackos” or “hippie-freaks” who need to “be put in their place” (an actual quote from an OB who refused to call an anesthesiologist for a laboring mother who transferred from home birth to get an epidural).

My goal as a childbirth educator has always been to present as true a collection of facts as possible and equip my students to know the full range of options available to them. My goal as a mother has always been to try to have a birth that best suited the individual pregnancy and child, as well as what my own research had shown me about what was right for me and my situation, in my local area.

I hope that this eye-opening study will be a much-needed first step towards an overhaul of birth care in America.

It surprised me to hear the percentage of guidelines with no true evidence in support. Did it surprise you to learn the numbers?

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