Evidence-Based Birth Practice VS Practice-Based Birth Evidence: Musings From A Doula And Childbirth Educator
In the realm of birth work, a crucial dialogue is unfolding regarding the relationship between evidence-based birth practice and practice-based birth evidence. Although these terms may appear similar, they represent distinct approaches to understanding and applying knowledge in perinatal care. As a doula, I have observed the convergence—and occasionally the tension—between these two paradigms, particularly in the context of decolonisation and rematriation efforts.
Understanding Evidence-Based Birth Practice
Evidence-based birth practice emphasises the use of clinical research and scientific data to guide maternity/parturient* care. This model prioritises peer-reviewed studies, systematic reviews, and medical guidelines to identify best practices. Notable organisations like the World Health Organization (WHO) and Cochrane Reviews provide invaluable research on labour interventions, pain management, and perinatal health outcomes. Evidence Based Birth, the organisation through which I earned my certification as a childbirth instructor, has been instrumental in disseminating this evidence to parents and professionals.
The primary goal of evidence-based practice is to ensure that birthing individuals receive care that has been rigorously tested and demonstrated to improve outcomes. For instance, studies show that continuous labour support from a doula can lead to reduced cesarean rates, shorter labour durations, and increased maternal satisfaction. Consequently, many hospitals and birth centers now encourage doula involvement as part of their evidence-based strategies.
When working with my clients, I often turn to research articles to counteract medical misinformation that can spread online and sometimes even in doctors' offices. Adopting this approach is essential for engaging in meaningful conversations about advocacy and birther-led care, especially when information yields power.
However, evidence-based practice has its limitations. Research can lag behind emerging techniques, and some birthing practices might be challenging to study in controlled settings. Furthermore, systemic biases in research funding and methodology often overlook culturally significant birth traditions and alternative care models, such as those practiced by indigenous midwives in Mexico, Bolivia, and other regions of South America.
Defining Practice-Based Birth Evidence
Rather than viewing practice-based evidence as the opposite of evidence-based practice, I see them as interconnected concepts—much like the overlapping circles in a Venn diagram. Practice-based birth evidence emerges from lived experiences, anecdotal reports, and the collective wisdom of birth professionals and families. This knowledge is derived from hands-on practice and real-world outcomes rather than controlled clinical trials. Such wisdom, often passed down through generations, remains elusive yet deeply impactful. For example, some practices, like eating dates to help ripen one’s cervix, have been clinically studied, yet many others lack formal research.
Midwives, doulas, and traditional birth attendants often draw upon this experiential knowledge to inform their work. While I emphasise evidence-based practices in hospital settings, I cultivate curiosity and compassion toward less conventional methods. A prime example involves maternal positioning for improved fetal alignment—an area with limited clinical research but rich in ancestral wisdom. Traditional practices, such as using the Rebozo in Latin America or the Javanese Lenggang Perut technique, showcase the depth of indigenous birth knowledge that survives outside formalised healthcare systems.
Rematriation and Decolonisation in Context
As I explore the interplay between evidence-based and practice-based birth evidence, it becomes essential to contextualise this dialogue within decolonisation and rematriation frameworks. The revival of traditional practices has played a pivotal role in rematriation efforts aimed at reintegrating midwifery-led care into the maternity/parturient system—research supports that these approaches often yield better maternal/parturient and fetal outcomes.
However, calls to "professionalise" midwifery through accreditation can inadvertently perpetuate linear, obstetric-led models of care. In some situations, entire cultures can be harmed or worse, erased.
The scrutiny surrounding the Rebozo—a widely used technique in childbirth education—demonstrates this potential harm and erasure very clearly. Commercialisation of indigenous practices, like the Rebozo, raises questions about the respect and authenticity of these traditions, leading to calls from indigenous midwives to avoid its use in doula training. I am encouraged that organisations I am affiliated and accredited with, such as Spinning Babies and DONA International , have actively addressed this issue, advocating for appropriate usage. Additionally, I’m thankful for organisations like Wombs of the World who are doing commendable work in educating birth workers about traditional birth practices, and practitioners like Naoli Vinaver offer hands-on workshops on the Rebozo.
Moving Forward
In Latin, evidence means obvious to the eye and mind. The etymology is fascinating as it seems to address tensions between western-centric models of proof, to age-old observable indigenous practices of the Global South. It begs us to go beyond the rigour of the mind and see what is most visible in front of us. I take comfort in this knowledge; perhaps we can all arrive on the same page one day.
This is an ongoing conversation that is close to my heart. As I navigate the complexities of working both within and outside hospital systems, I am embracing not needing completeness and distinctions when I’m facing challenges to my role as doula and birthworker. It’s been a long time coming, but I've shifted my perspective from seeking definitive answers to living with and embracing the questions we encounter as living, evolving beings. Rainer Maria Rilke poignantly expressed this idea, and it’s something that I return to whenever I feel challenged by big questions.
“Be patient toward all that is unsolved in your heart and try to love the questions themselves, like locked rooms and like books that are now written in a very foreign tongue. Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.”
I would love to hear what you think. Send me an email - let’s chat.
*I started to use the term “parturient” (a person about to give birth or in labour) or “partuition” (of giving birth) to acknowledge non-binary people who may not identify as maternal and/or have not received gender-affirming care within the birthing world. This is also to acknowledge the labour of people who are surrogates and who may not identify themselves as being the “maternal” person or the one in maternity, given the term’s multi-layered connections with mothering and parenting.
