Evidence Based Maternity Care | What is Evidence Based Maternity Care & What everyone ought to know.


“When my doctor or midwife suggests something for me (and the baby), it’s based on solid evidence & the best research…right?”

A Columbia University study reviewed the American College of Obstetricians and Gynecologists (also known as ACOG-they represent 90 percent of U.S. board-certified OB/GYNs) practice bulletins and found “1/3 of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence.” See the study here.

Woah there turbo! Yikes.

The words: “Evidence Based Maternity Care” sound kinda high falutin’, but it might be the most important thing you learn as you become a mom. Why?

If your & your baby’s care isn’t based on medical evidence, what is it based on?

And the easy question after that…do you want care (or trust care) that’s based on anything other than “medical evidence?”

Research shows how often maternity care is not based on scientific research & evidence, but rather a provider’s opinion, feeling, thoughts or something else. Don’t just take our word for it- read what the medical community themselves are saying….

Have you seen our FREE podcast in iTunes – Sarah interviews Cindy Crawford on “How I Managed Pain in Birth” … you’ll be inspired by what Cindy shares! Click here to see the Podcast (if you like the podcast, it would really help us if you left a 5 star review… thanks friends! xoxo Sarah)

The World Health Organization talks about Evidence Based Care here.

A team of national experts at The Journal of Perinatal Education, spent 2 years reviewing 15 1/2 years worth of medical evidence, studies & literature (in the U.S.). They concluded many routine medical interventions used during birth do not improve birth outcomes for mothers and babies. Some can cause harm.

Does that blow your mind? It blew ours.

Read the evidence found at the U.S. National Institutes of Health’s National Library of Medicine right here.

All the incredible doctors, nurses, midwives & other healthcare professionals we’ve interviewed at hope you understand one thing. All healthcare is not the same.

Do you want the 5 star gold standard healthcare for you & baby or a “fly by the seat of the pants” version?

Both exist in your city. Evidence Based Maternity Care gives you & your baby the best (5 star) evidence & research based health care available in the world. It’s the cats’ meow, the cream of the crop, the bees knees (you get the point). Would you want anything else?

But isn’t it improper to ask questions about what a health provider does or says?

That’s an easy one. No.

Think back a moment to the time when it was improper for a woman to vote, have a career outside the home, to talk about sex, or to say much of anything on her mind.

As a culture we’ve become used to being that same way when it comes to healthcare providers. But that doesn’t give you the best care for you & baby. If you want the best care, being a proactive partner in health WITH your provider is key. Alot of times, it’s simply asking questions.

“You must actively participate in your & your baby’s care if you expect to receive its benefits” Jessie Gruman, President, Center for Advancing Health click to tweet

Asking questions kicks it up a few notches and means that you give a darn. Once you become a parent, you’ll quickly find that sometimes all you do is ask questions (or answer them, if you have toddlers).

But somewhere along the way it’s become routine to roll into a hospital just wanting to roll out with a baby, without any question asking or collaborating with your provider. It’s become “normal” to  follow & accept a provider’s opinion without understanding the options, the risks & the big motherload question: “why” behind it.

When has that ever been a good idea? {for anything}

Asking  questions is easy to do. For example, you could ask questions like:

 “Why is this medically required?”

“Am I or my baby in any danger requiring this procedure?”

” Why?”

“What other options do we have?”

Check out this interview with Dr. Lucky Jain, one of the world’s leading neonatologists, he talks about the importance of question asking, “collaborative care” with your provider & the unique partnership that exists between a provider & mom. 

Let’s bring it home. Weddings. Let’s say you hired a wedding planner & your wedding day is all planned out. Well on your wedding day at the resort, the planner tells you instead of a live band you’ll be using an ipod, that your ceremony has been moved into one of the big convention rooms {instead of outside} & that instead of those fancy appetizers you wanted, you’ll be served meatballs. Would you just blindly accept that or might you ask… “Why? For what reason? What do you know that I don’t know? Is there a way to have what we really want? How do you suggest we make that happen? Are there other options besides an ipod, indoor wedding & meatballs? What are they?”

Assuming you wouldn’t blindly say “yeah sure”… doesn’t it seem crazy we’d just blindly follow what our provider says without asking for evidence, reasons & explanations to back up decisions that are guaranteed to affect our & our baby’s health now & potentially forever?

Evidence-based maternity care uses the best available research on the safety and effectiveness of specific practices to help guide maternity care decisions and to facilitate optimal outcomes in mothers and newborns” says Childbirth Connection, whose mission is to improve maternity care through research, education & policy. 


Okay okay. So how does this really impact me?

Great question! Thanks for asking;)

Let’s cut to the chase… There are procedures that some providers commonly suggest & routinely do which are not medically required- and actually increase the chance of you getting surgery, or having other procedures done that otherwise wouldn’t be necessary. (Learn from one mom’s experience with different types of providers & who she hands down go with next time right here.)

Say What? What does that mean?

It means you might be encouraged by your provider to receive a “routine procedure”, when the medical research & evidence shows it’s not medically required. And that routine procedure might increase the chance of other procedures…then other procedures…then other procedures, etc. Picture a snowball at the top of the hill that starts rolling down and gets bigger & rolls faster.

This is important to understand, because it happens a lot. It means you might be taking on unnecessary risks because the procedures are medically unnecessary. 

So how about some specific examples of medical interventions done with little or no medical reason?

*many of these studies come from the US Cochrane Center at the Johns Hopkins Bloomberg School of Public Health

**these procedures are valuable interventions when medically required. It’s the routine use when no medical need exists, that introduces risk unnecessarily.

Continuous Electronic Fetal Monitoring- is when you’re hooked up to a machine that continuously monitors baby’s heart rate. Providers use it to simultaneously manage your labor & the labor of lots of other women from one central point. Being hooked-up restricts your movement & usually requires you to stay in bed. This prevents you from using the tub, shower and may restrict you from other laboring positions that women consistently report & the medical evidence says reduces pain & speeds up labor (should you want that freedom). The evidence says continuous electronic fetal monitoring significantly increases your chances for a C-Section, but does not improve the outcome for your baby (assuming normal birth). This study involved over 13,000 women.

The intent of continuous electronic fetal monitoring is to manage labor without providing continuous labor & birth support by your side. But the evidence actually shows continuous labor & birth support (i.e. doulas, etc.) has clinically measurable benefits & tons of advantages.  Evidence from studying over 15,000 women says Continuous Birth Support:

  1. Decreased the chances of a C-Section, use of forceps delivery or vacuum assisted birth 
  2. Decreased likelihood of women asking for pain medications 
  3. Shortened labor 
  4. Improved likelihood of spontaneous vaginal birth 
  5. Had more women likely to be satisfied with birth experience. 

You have another SAFE option. The other option is intermittent electronic fetal monitoring, which measures baby’s heart rate just the same, but at scheduled times, giving you the freedom to move around (should you want it).

The American College of Obstetricians and Gynecologists (ACOG) & World Health Organization do not recommend continuous electronic fetal monitoring in low-risk women. Yet many hospitals still hook you up immediately. Why?

Eating & Drinking- Most hospital protocol won’t allow you to eat or drink during labor or birth. Evidence does not support this. This protocol was established about 50 years ago when general anesthesia was routinely used during birth. General anesthesia is very rarely used today. Most hospitals don’t want you to have food & drink in case of an Emergency C-Section. Despite the facts, many providers still restrict eating & drinking for normal labor. Like any other physically & emotionally demanding event, you need calories for energy & strength. Research says you should nutritionally eat & drink as you wish during labor & birth- see the evidence.

Breaking Your Water- (AKA- Artificial Rupture of the Membrane)- This was originally done to stimulate hormone release to speed up labor & ultimately thought to decrease chance of C-Section. “Evidence does not support the routine breaking the waters for women in spontaneous labour (sic)” says this study from University of Liverpool, Department of Public Health of 4,893 women. Their conclusions… labor did not speed up, but the chance for C-Section increased.

Your amniotic-sac acts as a buffer (like bubble-wrap) protecting your baby’s head & your vagina during labor. Artificially breaking your water increases the chance of infection (especially when you’re constantly being checked vaginally to see how dilated your cervix is). The people constantly checking are actually the ones who introduce infection (ie- nurses check, then doctors check, then new nurses & new doctors keep checking after shift changeover) & most of the time there’s no medical reason to be checked over & over (according to multiple doctors, nurses & midwives). Doesn’t it make you wonder…If there’s no medical benefit, no improved newborn outcome & it actually increases the chance for a C-Section…why is it so common?

Giving Birth on Your Back- This is called the lithotomy position and is considered by some to be the worst position. It’s also considered by many to be the most painful. When women labor & birth lying down, their pelvis cannot physically open as much, resulting in the birth canal being up to 30% smaller. That also means pushing baby against gravity causing more pain, more issues with baby’s heart rate decelerating & more chance for forceps assisted delivery. So unless a laboring mama feels most comfortable lying on her back, why is it THE defacto laboring & birthing position? Read the Evidence about birth positions & learn more about birth positions here

Episiotomies- Evidence says the routine or liberal use of Episiotomy does not offer benefits & actually exposes women to risk of harm. So why do providers routinely use them? And why do women let them, unless there is clear medical need? Data from 1950-2004 was searched & 26 papers provided- read the Evidence on Episiotomies.

Early Umbilical Cord Clamping- The placenta continues pumping nutrient rich blood (containing stem cells) & oxygen into baby for about 2-4 minutes after birth. Unless there’s big time urgency, clamping the cord early deprives baby of exactly what it needs most during its transition into the world…oxygen & blood. It’s proven that baby gets up to 32% more blood by delaying the clamping until the cord stops pulsing (which means more oxygen too). That blood has been shown to prevent iron deficiencies up the age of 6 months. According to the evidence, there aren’t any serious drawbacks or risks in delayed cord clamping. Regardless of these clinical benefits, lots of providers (we’ve heard ‘most providers’ from nurses) still “clamp & cut” the umbilical cord immediately after birth. You’d most likely have to ask for delayed clamping, then make sure your provider or nurse actually does it. Why?

“Delayed cord clamping clearly increases fetal hemoglobin, blood volume and iron stores. The evidence supports a clinical benefit of delayed clamping. There’s really no strong evidence against delaying the cord clamping. When we talk about interventions in medicine, really, the burden of evidence is on the intervention.” Dr. Nicholas Fogelson AP School of Obstetrics & Gyn- USC School of Medicine

Do you want to delay clamping your baby’s cord for 2-4 minutes so they get all those benefits? That’s the macdaddy question. Read Evidence on delayed cord clamping here.

Inducing Labor- Inducing is a valuable intervention when medically required. According to the American College of Obstetricians & Gynecologists medical reasons include:

  • -water broke & labor hasn’t begun
  • -you are over 42 weeks (normal pregnancy is 38-42 weeks)
  • -diabetes that might affect baby
  • -you have infection
  • -baby is growing too slowly
  • -you have high blood pressure caused by pregnancy

When the risks of your baby staying in utero are greater than the risks of inducing labor- that’s when inducing is considered medically required. See our Get Smart article on Induction.

Can we be candid for a sec? Some providers offer to induce like they’re giving you a mani or pedi or something. They say “Hey, why don’t ya come on in on this date & we can induce”… when none of the medical reasons listed by the American College of Obstetricians and Gynecologists (the professional organization making recommendations for 90% of all obstetric providers- OBs & midwives) above have happened or are happening. 9 out of 10 times induction is done with the drug Pitocin.

The Pitocin label says right on it: “IMPORTANT NOTICE-Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction. Since the available data are inadequate to evaluate the benefits to-risks considerations, Pitocin is not indicated for elective induction of labor. Antepartum: Pitocin is indicated for the initiation or improvement of uterine contractions, where this is desirable and considered suitable for reasons of fetal or maternal concern, in order to achieve vaginal delivery. The FDA has not approved Pitocin for elective inductions.” Here is the FDA approved label.

Pitocin can be a life-saving drug. And like any drug, it also has risks. Many providers never talk about the risks you accept, for the sake of convenience, as if there are none. Is it important for you to understand how a drug’s risks might affect your baby & you? Is it worth adding risk if there is no medical need requiring that risk? It’s your decision and don’t you think you should be educated so you can make the best decision for you?

But my baby’s too BIG. A summary of the Evidence says… “It is also important to know that suspecting a large or very large baby is not a medical reason for induction. Studies have shown that inducing labor for macrosomia (large baby) almost doubles the risk of having cesarean surgery without improving the outcome for the baby. Furthermore, it is very difficult to know how big your baby is until it is born. Ultrasound is not good at predicting which babies are macrosomic (very large). As many as 70% of women who are told they are carrying a macrosomic baby are actually carrying a normal-weight baby (ACOG, 2004b).” This entire quote is a summary of evidence found here & more evidence here. Ask around, you’ll hear lots of moms who had this exact scenario. It happens all the time.

So why are pregnant mamas very commonly told a c-section is required? Why are some hospital c-section rates 15%, while others are 45% (and the hospitals are across the street from each other)? If all hospitals practiced Evidence Based Medicine, can we medically justify 30% more women can not give birth vaginally in one hospital but can give birth vaginally in another across the street? 

Doesn’t it seem like there’s a disconnect somewhere?

If you want a vaginal birth, you probably will not want to go to a doctor or hospital with a 45% c-section rate.  These are important things moms who’ve been through these situations wish they knew to AVOID the situation altogether.

Here’s the kick in the pants… According to the United Nations, the US ranks in the bottom of industrialized nations in infant & maternal health indicators. We’re using the world’s best & highest trained surgeons for birth, we have the best technology on the planet, we’re just about the highest vaccinated country in the industrialized world (if not the highest) & we spend more on healthcare than anyone else in the world (according to the World Health Organization’s 2010 World Health Report).

How is it possible we rank so low?  Do those facts make sense to you?

It starts with us. So what are we gonna do about it? As always there are options:

1. Cruise in to a provider, leave everything to them, be a bystander and let your childbirth happen to you.

2. Learn enough to ask kick ace questions which will build your confidence and help you have the best birth possible WITH your provider. You’ll function like “the dream team.” It’s a win-win for you, your baby and your provider.

The Takeaway…

Let’s ask questions about the care we’ll get. No one will look out for our baby or us better than we will. Amazing providers (doctors & midwives) are out there. We find them by asking good questions & not accepting anything but Evidence Based Care. 

If your Maternity Care isn’t based on Evidence Based Care, what’s it based on?

Leave your email below for {FREE} updates