Evidence based care (aka evidence based practice) is a phrase that gets tossed around a lot. It is frustrating to me, a health care provider that aims to provide evidence based care, it is frustrating when I hear other providers say that their patients ‘refused evidence based care” as if evidence were the only part of the equation. Nope.
Evidence based care has three parts: the evidence, the provider, and the client. All three are important. And those three parts come together to form evidence based care for the individual client. The client is a crucial part of the equation. This means that for two clients with similar medical histories and the same provider, evidence based care might lead to different actions for each.
Let’s look at vaginal births after prior cesarean section (VBAC) as an example. There is lots of evidence that VBAC can be a safe and reasonable option. I am a midwife that is experienced with attending VBACs. I could have two clients that are both 30 years old, both pregnant with a second baby, and the first baby was born by Cesarean Section after an induction of labor at 42 weeks (2 weeks past the due date). Both of these theoretical clients had the same type of surgery (low transverse uterine incision with a double closure) and no complications with recovery. Both clients waited over a year to get pregnant after their surgeries, and the current pregnancies are proceeding normally with no complications. With each client, I go over the evidence concerning both VBAC and elective repeat C/S, my professional experience with attending each type of birth, and the client’s own values, concerns and desires. One client might leave the discussion planning on a VBAC. The other might leave with a plan for an elective repeat C/S. Either way, evidence based care was practiced.
Get it? Evidence based care is not JUST about the evidence. It is not JUST about the provider (or institution). Nor is it JUST about the client. Evidence based care is a three legged stool: evidence, provider, client. All thee legs need to be sturdy for the care to be well supported.
May all babies be born into loving hands