Making Evidence Based Birth Decisions: Understanding the Research and Your Options

From the moment moms find out they’re expecting a baby, they’re bombarded with contradictory advice and conflicting opinions, on everything from what supplements to take to how they should (or shouldn’t) give birth. 

Water births, epidurals, c-sections, fetal monitoring—everyone has strong opinions on all of these things, and it’s hard to know what’s true and what’s just misinformation. 

We want to make the best decisions for us and our baby, but how can we do that when we don’t know who to trust and what to believe? 

That’s why Dr. Rebecca Dekker created Evidence Based Birth—to cut through the noise, give moms the real data, and empower them to make empowered, informed decisions about their labor and birth plans. 

This week on The Momwell Podcast, she joins me to discuss what evidence based birth is and how moms can make the best decisions for themselves. 

Evidence Based Birth and Informed Consent 

After experiencing a traumatic birth, Dr. Dekker turned to the evidence to understand what happened to her—and she discovered that not all standard practices are supported by data. 

When she found that 20-45% of moms experience birth trauma, she knew that things needed to change. She started Evidence Based Birth to equip moms with evidence about their options so they can make informed, empowered decisions. 

Dr. Dekker said that there are three components of an evidence based birth:

• Accurate information about benefits and risks to help inform your decisions
• A care provider who stays current on research and can help you apply it to your situation.
• Your goals, values, and preferences 

Unfortunately, having an evidence based birth is often easier said than done. One reason why is social media promoting horror stories and spreading myths about the birthing experience. 

It’s important to advocate for yourself—but not to make decisions based on fear. Dr. Dekker said the key to empowered birth is setting aside pre-existing bias and distinguishing fact from misinformation. 

Birth can be unpredictable—but that doesn’t mean that you don’t deserve to be listened to or have informed consent. Dr. Dekker said that informed consent is when you have accurate and complete information, plus the ability to say yes or no without experiencing pressure or coercion. We have bodily autonomy—and that right should not go away when we’re in labor. 

When you are armed with quality evidence and science-backed research, you can carve out the birth plan that feels right to you and advocate for yourself and your baby at every step of the process. 

What the Research Shows About Fetal Monitoring 

One of the decisions moms face when planning for an evidence based birth is whether to consent to ongoing electronic fetal monitoring (EFM). EFM continuously monitors the baby’s heart rate throughout the birthing process—and it’s the standard monitoring method in most hospital settings. 

Dr. Dekker said that EFM was introduced into Western healthcare in the 1970s without research or testing. Early advocates claimed EFM would help detect cerebral palsy and birth injuries. 

But it isn’t the only option for safe fetal monitoring. Intermittent auscultation, or periodically monitoring an infant’s heart rate with a Doppler device, is another option. Moms might not even realize that they can opt for this method. 

Dr. Dekker said that comparative tests between EFM and intermittent auscultation show an increased risk of C-sections, but don’t show consistent improvements in detecting cerebral palsy. The evidence indicates that EFM can increase the risk of unnecessary C-sections and interventions due to false positive readings. 

It’s important to understand the evidence and the options you have. 

EFM also often imposes movement restrictions for moms—even modern wireless electronic monitoring requires minimal movement for accurate readings. But many moms want to move freely during labor. Intermittent auscultation allows them to. 

There isn’t necessarily a best choice—but it’s important to understand the evidence and the options you have. 

Movement, Labor, and Birthing Positions

Another important factor in evidence based birth is birth and labor position. Conventional thinking is that moms should labor on their backs—but movement is a natural coping strategy.

Dr. Dekker said that an upright position can help your baby come down because of gravity. It also keeps you off the aorta, which is the largest blood vessel in your body. Because of this, lying on your back can actually compromise blood and oxygen flow. 

Movement during labor is a natural coping strategy.

She also said MRIs indicate that your pelvis widens when you squat, kneel, or are on your hands and knees—many moms find these positions less painful. 

An upright position also enables stronger uterus contractions, getting baby into an optimal delivery position.

Dr. Dekker said that evidence shows that birthing balls can reduce back pain during labor, and indicates that peanut balls might lower the risk of C-sections. 

Just because lying on your back is the traditional position doesn’t mean you have to. You can maneuver and reposition based on what feels right to you. Dr. Dekker said that nurses aren’t always trained or willing to help with a variety of positions—so you might need a partner, support person, or a trained doula who understands different positions to experiment with. 

The Evidence Based Benefits of Water Birth

Water birth has become a trendy topic…but is it evidence based? Dr. Dekker said that research does confirm the benefits of water birth. 

In a water birth, you pus and deliver in a tub of warm water—and the baby is brought to the surface immediately after being born. 

 Dr. Dekker said that studies show many potential benefits of water birth including: 

• Lower pain ratings
• Less use of pain medication
• Less use of Pitocin 
• Shorter labors 
• Lower rates of C-sections
• Lower rates of tearing
• Less use of episiotomy
• Lower rates of postpartum hemorrhage 
• More positive birthing experiences

Dr. Dekker said that evidence shows that water births are safe for moms and babies. The only adverse outcome is a slightly elevated chance of the cord snapping—a 0.57% chance during water births compared to a 0.37% chance in non-water births. 

While water birth is more common in birthing centers or home births, some hospitals do offer it. 

If you’re interested in a water birth, there are waterproof EFMs and Dopplers available for fetal monitoring. If these aren’t an option, you can also position your stomach slightly out of the water for monitoring. 

What the Evidence Says About Gestational Diabetes Testing

It’s common practice for moms to be tested for gestational diabetes during pregnancy. If untreated, gestational diabetes can be harmful for both mom and baby. 

There is some controversy around gestational diabetes. The determining level isn’t hard and fast—and there’s been a debate about the numbers. It can also come with a stigma that leaves moms feeling unnecessary shame if they “fail the test.” 

Moms feel unnecessary shame if they “fail the test.”

But because of the potential harm, most experts believe that testing is necessary. The gestational diabetes test involves consuming a glucose drink, and then having blood drawn to test for blood sugar levels. 

Some moms have problems digesting the glucose drink, causing nausea, headache, or dizziness. This has led many moms to question whether they need to be tested or if there is another alternative. Some viral social media posts have questioned the safety and efficacy of the drink or wondered if we’re poisoning ourselves. 

The glucose drink is simply made from dextrose—and no studies show that it’s harmful beyond the common side effects. 

Dr. Dekker pointed out that alternatives often have similar side effects. Jelly beans are a common option—but studies show that the test is more accurate with the glucose drink. If you do have trouble tolerating the drink, however, consider asking your provider about other options. 

How to Make an Evidence Based Birth Plan

There are a lot of factors to consider when it comes to evidence based birth. Understanding the research and determining what aligns with your values can help you make informed decisions and the right birth plan for you. 

It’s important to remember that the unexpected can happen.

But it’s also important to remember that the unexpected can happen. This can leave moms feeling distraught when things don’t follow their birth plan. 

Dr. Dekker recommended moms create a birth plan file with several backups in case of unexpected changes. The headings could be topic-based— water births, fetal monitoring, epidural option, transfer logistics (if you deliver at home). 

Backup plans provide flexibility and allow you to maintain autonomy even when things don’t go ideally. Dr Rebecca said moms who educate themselves and prepare documented birth plans are less likely to feel disappointed if they have to make changes.

When you arm yourself with research and advocate for informed consent, you can make empowered, evidence based birth decisions.