If you spend any time in the world of pregnancy, birth, and postpartum care, you’ve likely heard the term “evidence-based” thrown around a lot. Many doulas, midwives, doctors, and hospitals claim to use “evidence-based practices” or offer “evidence-based care.” But what does that actually mean? And how can doulas use evidence-based information to better support their clients?
In this post, we’ll break down what it means for something to be evidence-based, why it matters in the birth industry, and how doulas can use this approach to provide the best possible support for birthing families.
What Does “Evidence-Based” Mean?
At its core, the term “evidence-based” refers to using the best available scientific research to guide decisions and practices. In the birth industry, this means that medical interventions, policies, and recommendations should be based on high-quality research, clinical expertise, and patient values.
The concept of evidence-based practice comes from the medical field, where it was developed to ensure that healthcare professionals make decisions not based on tradition, personal opinion, or outdated information, but rather on rigorous scientific research and proven outcomes.
Evidence-based care relies on three key components:
- The Best Available Research: Peer-reviewed studies, systematic reviews, and clinical trials that examine the safety and effectiveness of interventions.
- Clinical Expertise: The knowledge and experience of healthcare providers, including obstetricians, midwives, and nurses, in applying research findings to real-world situations.
- Patient Preferences and Values: The needs, preferences, and values of the person receiving care must also be considered in decision-making.
Together, these three components create a balanced approach to care that is scientifically sound, practical, and respectful of individual choices.
Why Does Evidence-Based Care Matter in the Birth Industry?
Pregnancy and childbirth have a long history of being shaped by cultural traditions, hospital policies, and provider preferences, rather than by scientific research. For much of modern history, many medical interventions were introduced without strong evidence of their necessity or safety.
For example, practices such as:
- Routine episiotomies (cutting the perineum during birth) were once standard, but research now shows they often do more harm than good.
- Immediate cord clamping after birth was widely practiced for decades, but evidence now suggests that delaying cord clamping improves newborn outcomes.
- Continuous electronic fetal monitoring is often used in hospitals, but research shows that in low-risk pregnancies, it does not improve outcomes and increases the risk of unnecessary interventions, such as cesarean sections.
When care is not evidence-based, it can lead to unnecessary interventions, increased risks, and negative birth experiences.
By contrast, evidence-based care supports safe, effective, and individualized decision-making, ensuring that birthing families are receiving care that is based on the latest and best scientific knowledge.
How Can Doulas Use Evidence-Based Information?
Doulas play a critical role in bridging the gap between research and practice by helping their clients understand their options and advocate for care that aligns with the best available evidence. Here’s how doulas can integrate evidence-based information into their work:
1. Educating Clients About Their Options
Doulas are not medical professionals, but they can and should help their clients understand the research behind common birth interventions and choices. This includes:
- The benefits and risks of medical interventions (e.g., induction, epidurals, cesarean sections)
- The evidence behind natural pain management techniques (e.g., hydrotherapy, movement, breathing techniques)
- The importance of informed consent and the right to decline procedures that are not medically necessary
2. Encouraging Informed Decision-Making
Evidence-based care empowers birthing individuals to make informed choices rather than feeling pressured into decisions based on hospital policies or provider preferences. Doulas can help clients:
- Ask the right questions: “What are the benefits, risks, and alternatives to this procedure?”
- Evaluate whether a recommendation is supported by research or just routine practice
- Communicate their preferences effectively with their healthcare team
3. Providing Up-to-Date, Reliable Resources
A well-informed doula stays current on research and guidelines from reputable sources, such as:
- The World Health Organization (WHO)
- Cochrane Database of Systematic Reviews
- The American College of Obstetricians and Gynecologists (ACOG)
- National Institutes of Health (NIH)
By directing clients to reputable sources, doulas help them avoid misinformation, outdated practices, and fear-based decision-making.
4. Advocating for Evidence-Based Practices in Birth Settings
Doulas are often witnesses to hospital policies that don’t align with the latest research. While doulas must remain professional and work within their scope, they can:
- Encourage clients to ask for evidence supporting a provider’s recommendations
- Support shared decision-making by helping clients navigate hospital protocols
- Advocate for physiologic birth practices where appropriate (e.g., movement during labor, uninterrupted skin-to-skin contact, delayed cord clamping)
5. Debunking Myths and Misinformation
With social media and the internet full of conflicting advice, doulas can help clients separate fact from fiction.
For example:
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Myth: “Once you have a C-section, you always need a C-section.”
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Evidence-Based Fact: Many people are candidates for Vaginal Birth After Cesarean (VBAC), and research supports VBAC as a safe option for most.
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Myth: “Pitocin-induced contractions are just like natural contractions.”
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Evidence-Based Fact: Pitocin contractions tend to be stronger, more frequent, and more intense, which may increase the need for pain medication.
By countering misinformation with solid evidence, doulas help their clients make informed choices that align with their personal goals.
The Challenges of Evidence-Based Care in the Birth Industry
Even though evidence-based care is the gold standard, many birthing people still encounter resistance to it in hospitals and healthcare settings. Some common challenges include:
- Hospital Policies Overriding Best Practices: Some hospitals have protocols that are outdated or not based on strong evidence, such as mandating continuous fetal monitoring for all laboring individuals.
- Provider Bias: Some healthcare providers continue old habits or make decisions based on personal experience rather than research.
- Lack of Access to Research: Many birthing individuals don’t have access to medical journals or know how to interpret scientific studies.
Doulas can help bridge these gaps by guiding clients through the decision-making process and supporting their right to informed, evidence-based care.
The Role of Evidence-Based Care in Empowering Birth Choices
In the birth industry, evidence-based care is essential for ensuring the safest, healthiest, and most positive outcomes for birthing individuals and babies. Doulas play a critical role in making evidence-based information accessible, understandable, and actionable for their clients.
By helping clients navigate research, advocate for themselves, and make informed decisions, doulas empower birthing families to take control of their birth experiences.
At Madriella, we believe that every doula should be equipped with the knowledge and tools to support their clients in making informed, evidence-based choices. By staying up to date on the latest research and continuously educating ourselves, we can help ensure that all birthing people receive the care and respect they deserve.