Frequently Asked Questions… that Other People have Already Answered!

Here at www.EvidenceBasedBirth.com and on my Facebook page, I receive many questions about the evidence for various labor and delivery practices. Unfortunately, due to my busy life as a professor and a mother of two, I don’t have time to write all the evidence-based articles that I would like. So that’s why I love to point people to evidence-based blog articles that other people have already written. Here are a few of my favorites!

Disclaimer: I agree with most, but not all, of the points listed in these articles. I probably would have written my articles in a slightly different style. But with that being said, I think these are reliable sources and that the authors cover the available research pretty thoroughly. 

Q: What is the evidence for delayed cord clamping?

A: Nicholas Fogelson (the Academic OB/GYN) has a series of articles on delayed cord clamping. You can read his original article here, a follow-up article here, and if you have time you can watch his grand rounds lecture on YouTube here. To sum it all up, delayed cord clamping has many benefits for both pre-term and term infants, although it does lead to a higher risk of jaundice. (The higher risk of jaundice is not surprising, really, since the breakdown of red blood cells contributes to jaundice, and infants who have delayed cord clamping have more red blood cells).

What does the evidence say about the timing of cord clamping? Credit: dsyzdek

Q: My doctor says that my baby has to stay lower than my placenta if I want delayed cord clamping. Is this true?

A: Dr. Mark Sloan (a pediatrician) has written an article about this and other controversies related to delayed cord clamping here. The short answer? No, the baby does not have to stay below the level of the placenta while the cord is still intact; it is perfectly fine for the baby to be in your arms!

Q: Is evening primrose oil safe to use during pregnancy?

A: Jen Kamel of VBACFacts.com looked at the very little research available on evening primrose oil and summarized the evidence here. Her conclusions? There is no evidence showing that evening primrose oil (EPO) is safe during pregnancy, and there may be potential harms.

Q: What is the evidence for letting the placenta come out on its own time versus giving Pitocin and putting traction on the cord?

A: Midwife Thinking wrote an interesting article about the evidence on this topic here, explaining why the evidence suggests that “active management” (giving Pitocin and putting traction on the cord) may be more beneficial for most women who give birth in hospital settings. (To understand why I highlighted those two words— “most” and “hospital”—read the article!). 

Q: Can you lead me to evidence-based research or randomized double-blind studies regarding placenta encapsulation?

A: As far as I can tell, no research on this subject exists!  Unfortunately, I can’t help you evaluate the research evidence if there is none to be had.

Q: I’m looking for information on epidurals. Can you help?

A: It’s not a blog article, but there is a great evidence-based resource about epidurals on Childbirth Connection’s website, which you can read here. The take-home point? Epidurals are highly effective at relieving pain but also carry many potential harms.

What are the potential benefits and risks of an epidural?
Photo credit: beglen

Q: Is suspected “big baby” a valid medical reason for an induction or C-section?

A: Jill Arnold from the Unnecesarean has written extensively about the research on this topic. You can see a list of her “big baby” articles here, or you can just check out this one (my favorite). Want the quick answer? Current evidence does not support early induction of labor for suspected big babies. Induction of labor doubles the risk of cesarean delivery without reducing the risk of shoulder dystocia or newborn morbidity. The same could be said for elective C-section for a suspected big baby—this practice is not supported by evidence.

Q: Was my Cesarean for “failure to progress” really necessary?

A: It would be inappropriate for me to listen to your story and tell you whether or not your C-section was necessary. However, research has shown that “failure to progress,” also known as labor dystocia, is a common cause of preventable C-sections. In fact, a substantial number of un-planned C-sections are due to “failure to progress,” and research shows that almost all of the time these diagnoses were made prematurely. The Well-Rounded Mama talks about how a woman’s failure to progress is frequently just the care provider’s “failure to wait”—especially when it comes to larger women.  You can read her evidence-based article here.

What are your favorite evidence-based articles? Please feel free to link to them!

Warning: comments with 3 or more links are usually sent to my spam folder, so please limit yourself to 2 links per comment.

If you liked this article, you may also be interested in:

Is erythromycin ointment always necessary for newborns?

What kind of fetal monitoring is based on evidence?

Does gestational diabetes always mean a big baby and induction?