According to a new study, nearly one third of all practice guidelines issued by the American Congress of Obstetricians and Gynecologists (ACOG) are based on “expert opinion” rather than actual research evidence.
In other words, doctors’ personal opinions and experiences may be the only “evidence” behind 1 in every 3 recommendations their professional group gives to member physicians, which then trickle down to the care that pregnant women receive. Pregnant women like me. And you.
Like many birth bloggers and advocates, my initial reaction was, “Well, duh. And this is why maternity care in the United States is such a disaster!” And then I went to the original source, read the full journal article and accompanying editorial for myself (an anal retentive habit of mine), and walked away with a more nuanced opinion.
When broken down, the stats look like this – for obstetrical care, in particular, just 25.5% of ACOG’s practice guidelines are backed by gold-standard research (i.e. well designed randomly controlled trials). Another 39.7% are backed by less rigorous research, and 34.8% are based on “consensus and expert opinion,” or simply what your doctor and his/her peers think is best.
This sounds appalling at first glance – just 1/3 of what OBs do is backed by the best research? Yikes! But there are a couple of issues to mention before we all get bent out of shape.
- Randomly controlled trials are really hard to do in many medical situations, particularly obstetrics, either because it would be unethical to randomly assign people to one research group or another or because it would be nearly impossible to find enough people to participate to make it worthwhile. Think about it – if your doctor said, “We’re doing a study comparing complications after vaginal births and elective c-sections. If you participate, we will pull names out of a hat and this will determine the type of birth you’ll have,” would you be game?
- Groups like ACOG issue opinions based on solid research whenever the solid research is available. But it’s not always available, so they have to do the best they can with what they have.
- Although the numbers presented in the study look alarming at first glance, the study’s authors looked around and it turns out that OBGYNs are not really so different from docs in other specialties.
All that being said, ACOG is still, ultimately, a lobbying group for OBGYNs and obstetrical care in the United States still needs improvement. Vast improvement. But rather than villainize ACOG for not basing every one of their clinical recommendations on flawless research, I have some alternative recommendations.
- Choose your pregnancy caregiver carefully. The first step to a healthy pregnancy & birth is finding the caregiver who is the right match for you. Don’t just choose a caregiver because s/he is “nice” or “has been fine for my annual exams the past several years” or because your friend had a great experience with him/her. Read up on pregnancy and birth issues, determine what sort of birth you’d like to have, and find a skilled caregiver that will help you get there.
- Challenge your caregiver on issues that are important to you and challenge him/her to be honest with you about how his/her biases or personal experiences have affected his/her practice. Medicine is a science, but it is also an art. Ask 5 different OBs the same question and you’ll likely get 5 different answers. Also, know that not all OBs follow all of ACOG’s guidelines. Try finding doctors who will fully and actively support vaginal birth after cesarean (a practice officially supported by ACOG), and you’ll see what I mean.
- If you’re a generally healthy woman with a healthy pregnancy, consider hiring a midwife. Midwives are trained in supporting normal birth, while OBs, by their nature, are trained surgical specialists. A normal, healthy pregnancy does not have to be a stressful high-risk medical event.
- Whoever you hire to help guide you through these months – do your homework and be your own advocate. Yes, your caregiver is the “expert,” but ultimately, it is your pregnancy, your birth, your health, and your baby. Own it.
For more information on healthy birth options, I also recommend checking out Lamaze International’s Healthy Birth Practices. Lamaze has done their best to look at the research themselves and distill it down into 6 basic recommendations to put you on the road to a safe, healthy, and empowering birth experience.
You deserve it.