Evidence?

I'm a big believer in evidence-based medicine.  I don't want a treatment just for the sake of doing something, nor do I want something that hasn't been proven to be beneficial and effective, with those benefits outweighing any potential risks/side effects.  I'm thankful that there are doctors who look at the evidence and change practises if need be.  This is what Dr Nicholas Fogelson is doing in now advocating for delayed cord clamping, since he hasn't seen evidence justifying routine immediate cord clamping.  This is also why routine episiotomies are becoming less common, thankfully.  And why kangaroo care is, thankfully, becoming more commonplace with preemies.

These things lead me to wonder, though, why these practises were adopted at all, given that the evidence doesn't seem to be there.  The commonality I see is that these were all things that said that our bodies were wrong and not to be trusted, or perhaps not "scientific" enough.  Maybe that's cynical, but it's how I see it.  In the process, women have been told (by implication) that they always need help birthing and caring for their babies.  Note: I'm not speaking of those times when medical intervention truly is needed, I am speaking about routinely treating birth as a medical procedure that will always need medical intervention.

Of course, one could also argue that all the things I mentioned above came about due to the medicalisation of birth and women being supine when giving birth in a medical setting, and sometimes too drugged or badly positioned to push effectively.  This could, of course, lead to an episiotomy instead of repositioning the woman, and immediately cutting the cord to check the baby instead of placing the baby on the mother's chest.  I'd like to say that these things no longer happen, or at least not with midwives, but both happened to me when I had K.  There was an OB there, too, so I'm not sure who made the decision for the episiotomy and immediate cord clamping; I only know that it was done, and that I had no say in it.  It's one thing if it's a true emergency (though one should always get informed consent if at all possible), but these things likely could have been averted had they just helped me change position first.

Going back to the cord clamping, though, I would again ask: where's the evidence for immediate cord clamping, even when the baby was thought to be in distress?  We know about the importance of immediate skin-to-skin contact to regulate the baby's temperature, calm the baby, and facilitate breastfeeding and bonding.  We also know that delayed cord clamping can be done even with active management of the third stage of labour.  While it might not be routine, the initial checks can be done with the baby on the mother's chest, allowing for both skin-to-skin contact and delayed cord clamping.  This could also mean that the baby will avoid being put in a warmer due to his temperature dropping (thankfully that didn't happen with K, as they did hand him over once he'd been checked over).

So before something is done my child or me, show me the evidence.

But We Must Do Something!

Maybe it's just me, but it seems that sometimes in medicine (thinking specifically of maternity/intrapartum/neonatal) the reason for doing something seems to be for the sake of doing something.  Maybe there's really a problem, maybe not, but the default often seems to be to do something, anything.  Now, I'm not saying action isn't sometimes justified, because it is, and I'm very grateful for modern medicine.  However, it seems to me, bearing in mind that I have no medical training, that it makes more sense to do nothing until and unless action is indicated.  Shouldn't we have to justify taking an action, instead of justifying not taking an action?  This is one reason I'm in favour of delayed cord clamping (see this page for Dr Nicholas Fogelson's thoughts on this), against routine infant circumcision, against continuous foetal monitoring, in favour of the woman getting to move around and eat and drink during labour as she wishes, in favour of a natural delivery of the placenta, etc.  Surely the default should be to leave the body alone unless it can be shown that an intervention is truly beneficial?  And that interventions shouldn't be used 100% of the time?  When interventions are indicated, I also feel that the least amount of intervention that will accomplish the goal should be used.  After all, we don't want to make McCoy's mistake when he was overly aggressive in treating Spock and temporarily blinded him.