Defining and Discovering What's "Evidence-Based"
What can octopi and pregnancy forums have in common?
Answer: *Slightly* more than you might think.
In learning more about pregnancy, childbirth, or doulas, you've hopefully run across the phrase "evidence-based". Whether used in conjunction with "care", "information", or "practice", "evidence-based" can come off as either incredibly straightforward ("yep, information is based on evidence, thank you, Captain Obvious") or like an extra feature, a bonus sunroof or seat warmer to your birth experience. While it's definitely a current buzzword in the birthing world, "evidence-based" has a specific meaning. When properly utilized, evidence-based practices are the foundation of informed and ideal care: both for me as a doula, and for you as a birthing person or someone supporting a birthing person.
We live in a time where information is incredibly easy and efficient to acquire. A quick internet search on topics like "pregnant exercise", "vitamin K shot", or "breastfeeding" will turn up hundreds of results. Though it's nice not to have to deal with the card catalog (yeah, I know how to use one- #just90skidthings), this convenience can potentially come at the price of the accuracy of the information that turns up. A classic example of this in action is the website Save the Pacific Northwest Tree Octopus.
This site is a hoax originally created in 1998. It's been used by educators for years to teach students how to identify reliable information. On an initial scan, the page can look credible: it's not ad-heavy, it has fairly recent links that lead off of the site, and the author seems to be an expert. There's just one problem: Pacific Northwest tree octopi aren't real.
While that fact alone is disappointing (I mean, look at how cute the octopus in the photo is), what's even more discouraging is what we've since learned about how people do (or don't) identify misinformation. A 2006 study by the University of Connecticut of 25 seventh-graders utilized the Pacific Northwest tree octopus site to see how students identified reliable sources. Regrettably, the study saw all 25 students fall for the hoax. Even when explicitly told that the page was fake, some of the students continued to passionately assert that, no, the Pacific Northwest tree octopus existed and needed help.
Now, of course, this study is over a decade old, didn't involve many individuals, and of course, studied middle-schoolers. If you're looking for research that shows that adults today can struggle to find accurate sources, here are just a few highlights:
This 2016 study of 376 million Facebook users shows that users tend to seek information that aligns with their current views, rather than more broadly researching.
This 2016 study shows how misinformation is quickly spread through social media networks in a "cascade effect".
This 2015 survey by the Pew Research Center finds that while Americans can generally answer basic questions about scientific concepts, they can struggle with actual applications of scientific concepts.
For many people, pregnancy is a time where they spend more time researching an aspect of their everyday lives than they ever have before. During pregnancy, your body is going through this new phase, where different things are happening to you than usual. Your identity may also be going through changes: you might be wondering "who am I now?" or "who will I become?" So, you want to better understand your current experience and what can happen next, so you can be the best parent possible. This leads to research and results in whole pages, forums, and Facebook groups full of people asking "Is _______ normal? Should _______ be happening? How do you feel about _______?" Sometimes, these groups are full of fantastic, reliable information. Sometimes, they aren't.
Everyone wants the best possible outcomes for their pregnancy and childbirth experience. No one wants to end up metaphorically trying to save the Pacific Northwest tree octopus. This is part of where the phrase "evidence-based" comes in.
"Evidence-based", when properly applied, means that a professional or a source is supporting your care and needs using current, up-to-date scientific research that is proven to work. Though as a doula, I do not function as a medical professional (learn more about my scope of practice here), I do provide informational support to my clients upon request. For example, if a client would like to learn more about options for exercise during pregnancy, I would advise them to talk with their provider before beginning exercise and would also provide them with several evidence-based resources about exercise options during pregnancy so that they can feel informed to discuss the topic with their provider. Common sources I work from to provide evidence-based information when requested include:
The American College of Obstetricians and Gynecologists (ACOG)
Now, let be said: just because something isn't evidence-based doesn't mean that I won't discuss it with my clients. There are (to my knowledge) no studies showing that a bath with a bath bomb is just better or that you should basically always at least double the amount of garlic in any recipe (see this tweet). Those are things I've found to be true in my personal experience, so they're valid for me as an individual. In the same way, I know the clients I work with have their own experiences of what does or doesn't work for them and preferences built from these experiences, regardless of whether they're actually evidence-based. If you were my doula, I hope you'd tell me to bath bomb it up and eat The Garlickiest Pasta Ever (so long as none of these practices interfered with advice from my practitioner!)
I am deeply passionate about helping the clients I work with to connect with and understand current science and to feel empowered to ask questions and make informed choices about their care. Evidence-based informational support is a key part of this goal: without knowing what science is current, you're not able to make truly informed decisions about your care. Without knowing what is or isn't evidence-based, you're not able to know what can make a significant contribution to outcomes during your pregnancy, labor, and/or birth. As just a few examples: evidence-based information shows that there are benefits to birthing in positions other than on your back, that doulas can improve outcomes for birthing persons and infants, or (as was adjusted in January 2019) that "laboring down" isn't beneficial for first-time mothers with an epidural.
Knowledge really is power: when we know what information we can rely on, we can spend less time worrying about saving the tree octopi and more time supporting our goals. Ultimately, we can work to achieve better experiences when we're guided by accurate and reliable information.