I trained as a midwife accepting that, if I wanted my work to be valued and trusted, I had to avoid basing my knowledge and my daily practice on intuition and unsystematic clinical experience. Guided by mantras like “the evidence says …” or “this is what the protocol recommends”, I allowed myself to be swept away by a disease-based model of medicine.
Evidence-Based Medicine guides the midwife in her daily practice and improves care for women and babies, relying on the analysis of the most complete and updated scientific studies. The disadvantages appear when the simple practice of non-intervention (recommended for a normal delivery) diminishes the quality of a potential study, as it will no longer serve as a reference; when women, whose role is essential, are not present in work groups, are not involved in decision making or in drafting recommendations; when many of the present-day interventions in normal deliveries and births are inadequate, invasive and iatrogenic, but still included in validated care protocols; when no scientific studies are able to include all of the nuances of a labour, many of them decisive and unquantifiable.
This is why nurses and midwives are recommending vitamins to pregnant women, performing toxoplasmosis, diabetes and streptococcus screenings, administering flu vaccines during pregnancy, performing cardiotocographies before week 40, defending hospital deliveries over childbirth at home in low-risk pregnancies, leaving the care of normal pregnancies and labours in the hands of gynaecologists, attending the expulsive phase of labour in the lithotomy position, administering prophylactic antibiotics in case of premature rupture of membranes or positive streptococcus, not allowing eating or drinking or getting out of bed during labour, performing episiotomies to prevent tears, performing Kristeller manoeuvres, clamping umbilical cords early, giving glucose-rich serums to babies, hindering the kangaroo method for premature babies in hospitals, … and unwittingly, we fill labours and birth care with habits and beliefs, and we sanction doubt, criticism and diversity, the true pillars of scientific thought. In your next pregnancy, if you hear “the evidence says …” or “this is what the protocol
recommends”, ask yourself if what your labour needs is the tortuous science of others, rather
than your intuition and experience.
Author: Sofía González Salgado, Midwife