Show Me the Evidence!

It’s a little tough staying up to date and integrated into debates happening in the birth world when you work solely in GYN, but a blog I read often, Science and Sensibility, is one of the best to keep involved in evidence based birthing practices and they ran a fantastic article on the Vitamin K debate that ran last week.

One of the biggest debates in the midwifery community is about Vitamin K injections that most babies are given after birth. When I myself was a midwifery student I often asked classmates, professors and other midwives I knew if they would accept or decline the Vitamin K injection for their babies. In thinking about my babies in the future, would my partner and I want to give them Vitamin K?

“Why even give Vitamin K?” you might ask. What’s so special about it? Well, it’s main purpose is to help babies clot their blood and prevent a massive, deadly, but rare, hemorrhagic event after birth.

Rebecca Dekker conducted detailed studies showing not only the efficacy but also documented the immense amount of research that has been done over nearly 70 years about Vitamin K. There is such a fuzzy understanding of what it does, who needs it, why it’s important, and I even debated about weather I would give it to my (future) babies after birth.

While I’m not having conversations with soon-to-be parents about weather or not to use Vitamin K or not, I do have many discussions every day about evidence based practice with my patients, to varying degrees of success.

For many reasons, pulling out new evidence can either give me an immense amount of credibility with patients, or it can earn me the sideways squinty-eye of doubt.

One of the most frustrating conversations to have with patients is about the evidence for side effects with birth control pills. Many women come back to me stating that since starting pills they have gained weight and are insanely crazy/moody/want to kill their partners. According to large studies that have been done over and over again, just as many women gain weight as lose weight on the pill. Just as many women experience mood disturbances, depression and anxiety on or off the pill. This doesn’t diminish the fact that the woman sitting in my office has experienced these things subjectively and that it is troubling to her, but I can’t help her point to the pill as a cause.

Furthermore, many women who get recurrent bacterial vaginosis infections want some sort of preventative therapy. We do it for women who get urinary tract infections often, but there is no real preventative treatment for BV. Why is that? Mostly because there is so little research done on women’s health in general. I have so little evidence to point to when it comes to vaginal infections, and that is frustrating for both me and my patient. I can recommend boric acid, which has shown some degree of success, but the studies are often observational, there is some anecdotal evidence, but not the wide-spread randomized controlled trials that I need to be able to say, yes! Try boric acid! This is the dose you need! It will help you!

Evidence is changing all the time, and sometimes it seems like there is so much to digest and learn and constantly keep up with. Being able to translate that into practice, and explain it to patients is similarly difficult. But what is even more frustrating is knowing that so little research and understanding of women’s vaginal and sexual health exists in your field because of rampant and systemic sexism that has left your field eons behind other areas of practice.

Upcoming on Soon To Be Midwife: The All-Encompassing Guide to Pap Smears, or, “Why are you sticking that pointy brush up there in the first place?”


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