In a recent Canadian study that was reviewed in The Journal of Perinatal Education, researcher Michael Klein, MD, reports that women are inadequately informed and care providers are not delivering evidence-based information when it comes to birth practices. (1) This dangerous combination makes it hard, if not impossible, for women to make informed decisions. A truly informed decision comes when a person has been given complete and unbiased information on which to base her action. Among the study's findings:
The women's lack of evidence-based knowledge about epidural analgesia included failure to appreciate that it interfered with labor and was associated with an increase in the use of forceps and vacuum. Many were unaware of the benefits and risks of cesarean surgery, including whether it was associated with urinary incontinence or sexual issues. The women's knowledge was also insufficient about the benefits and risks of episiotomy, the role of doulas in improving outcomes for mother and baby, and the place and mode of birth, including a birth center or home birth.
Further compounding the search for evidence-based information in birth is the diverse and conflicting information that is published in mainstream media. Earlier this month, articles from two different large media outlets questioned the true dangers of epidurals and whether they were overstated. (2,3) The articles provide both anecdotal information about each authors' birth experiences and point to scientific studies. After presenting and debating the science, author Melinda Wenner Moyer says, "Women shouldn't cave to pressure from either side. They should make informed decisions based on their goals and priorities." The problem is -- once again -- how can a woman develop her goals and priorities if she is not truly informed?
At the end of her piece, Moyer sums it up by saying, "My unnatural childbirth left me with a memory that does not involve intolerable pain, and that's exactly what I wanted." It's great that she achieved the birth she wanted! Unfortunately, however, her description negatively influences other mothers' perception of birth. My unmedicated (aka, "natural") third birth was painful, yes, but it was not "intolerable." When mothers believe that the pain of birth is intolerable (as many moms do in the United States), they are driven to choose an epidural without considering alternatives that can make birth just as enjoyable, not to mention healthy!
So with all the obstacles to becoming truly informed, how do you navigate the jungle of mass-misinformation-overload? Lamaze childbirth educator (and Giving Birth with Confidence contributor) Ami Burns responded aptly on the Lamaze Facebook page, "Yet another reason why comprehensive childbirth education is needed. Moms need the information -- even when research may be inconclusive -- so they can decide for themselves." Childbirth education, when chosen wisely, helps women look at all of the options by providing pros and cons, risks and rewards to the many decisions a woman can make during labor and birth. Contrary to what some may believe, a good childbirth class doesn't deliver the "natural birth or bust!" philosophy. A good childbirth class provides evidence-based information to help women be as prepared as possible to make the best decision for her and her baby.
How did you seek information on birth? What helped in your decision-making process? What hindered it?
(1) Klein, Michael C. Many Women and Providers Are Unprepared for an Evidence-Based, Educated Conversation About Birth. The Journal of Perinatal Education, Volume 20, Number 4, 2011 , pp. 185-187(3).(2) Moyer, Melinda W. The Truth About Epidurals. Slate. January 11, 2012.(3) Dell'Antonia, KJ. Are the Dangers of Epidurals Overstated? The New York Times. January 23, 2012.