Evidence Based Birth: Live in Louisiana!
I had the privilege of attending a dinner and conference with Rebecca Dekker from Evidence Based Birth. Many of you might use her website (professionally or for your own knowledge) or listen to her podcast! She started Evidence Based Birth in 2012 and it has flourished since. She described how there was a need in the birth community and she had a skill set so it was the perfect match. This weekend we had birth professionals, advocates, and members of the community travel up to 4.5 hours to listen to Rebecca talk and spark conversation among us. We walked away with many great tools and a better understanding of evidence based care and how to better the relationships between all people involved in the birthing process. We also got to talk A LOT about water birth, which I will save for a different post!
Evidence based care vs. Traditional care
For those of you that don’t know the difference between evidence based care and traditional care, here’s a little summary: Traditional care is when prior clinical experiences drive your actions. Evidence based care is being aware of the evidence you base your practice on. Evidence based care is composed of research, client goals, and experience. Evidence based care is is new (like past 25 years new) so many of our provides are not trained in this type of care and still approach their practice from a traditional stand point.
Horizontal violence & family centered care
We also talked about a term I hadn’t heard of before today but is very prevalent in the birth world: horizontal violence. This is violence directed at one’s peers. Usually the staff suffering from horizontal violence has A LOT of responsibility but very little power which results in conflict and often a big power struggle. When you go to birth at a hospital, think about how many people are really involved in the birthing process. Hospital lawyers, chief obstetrician, your obstetrician, nurses, doulas, pediatricians, etc. You get the picture. It’s a lot of people. Unfortunately, the people in charge are at one end of the spectrum and are so far removed from the birthing family. With this type of care, the birthing family is often left feeling powerless. Is this a familiar feeling to you? I know it is to me. I’ve personally felt the disconnect from care providers & nursing staff and have felt so powerless and out of control. It’s an awful way to feel as a birthing person. Here’s a picture from an activity we did today to help demonstrate this:
Rebecca had everyone line up from “most important” to “least important” demonstrating how many people are involved, who has the most “power”, and the disconnect from the people at the top of the line & the bottom. This also demonstrated how some of the people at the bottom of the line should actually be the ones with the most power.
Have you heard of family centered care before? Family centered care is a great way to give the power back to the birthing family and eliminate horizontal violence. With family centered care, the family is everyone’s main focus. The team kind of circles around the family collaborating together with shared responsibility for the family. Here’s a picture to demonstrate collaborative care:
Here, The birthing family is in the center of the circle & the team surrounds them. The team sees each other and nobody is removed from the birthing family.
A lot of facilities claim they operate in a family centered care manner, but unfortunately, this isn’t always the case. Louisiana’s statistics are showing we are way behind in the care we give our families.
Louisiana’s statistics:
cesarean rate of 37.5%
only 3.3% of births were attended by midwives in 2017
infant mortality rate of 7.6 per 100,000 live births
maternal mortality rate of 45 per 100,000 live births
73 per 100,000 for women of color
27 per 100,000 for white women
For comparison, the national cesarean rate is 32.7% and the maternal mortality rate is 26.4 per 100,000 live births (11 per 100,000 for white women and 41 per 100,000 for women of color)
What do we do from here?
These numbers should be appalling to everyone. We deserve better than this. What are some ways we can help improve these numbers? To improve our options and outcomes?
I was reminded today to start small. We have BIG dreams, but we cannot start at the top tackling the biggest issue first. Here are a few ways we can start making a difference in our community:
Make specific, manageable, time based goals. Start small then work your way up. Collaborate with peers to accomplish a few goals that you feel would better the birth community. These smaller goals will then act as a stepping stone to accomplishing a larger goal.
Birth workers- charge your worth. Charge your worth so you can put money aside to donate services to someone in need but can’t afford them. This will allow us to reach people deserving of care while being fairly compensated.
Take an independent childbirth education course. These classes are unbiased, detailed, and will give you and your partner the knowledge you need to go into your birth feeling empowered to make the absolute best choices for yourself and your baby.
Listen to your black friends. Women of color know what needs to be done. We need listen and follow their lead as friends and colleagues. Take trainings and workshops from black women, share their stories, listen without judgment, sponsor a woman of color’s doula certification so we have more black birth workers, and refer out to black doulas & midwives when possible!
Talk to young people. Start talking about birth to your children, your students, etc. Reach them when they are impressionable and want to know more. Start these conversations now so they can be better prepared when their time comes to give birth and start a family.
Expose providers and nurses to situations they might not be used to. Rebozo, unmedicated births, birthing in an alternate position, water births, etc. The more situations our providers are exposed to the less fearful of the unknown they will be.
I walked away from today feeling empowered and excited to do this work. I hope you feel a little more knowledgeable about birth in our state and some ways you can make a difference!
—Bella Birth Services