When Evidence Based Means Squat

Sometimes an evidence based choice is not the best choice.
Sometimes an evidence based choice is not the best choice.

Recently we had been having some troubles with my youngest son having emotional outbursts. We finally went to the doctor and his diagnosis (from seeing us for all of five minutes, after sitting in his boring office waiting room for over an hour right after school with no chance to grab snacks) was a lack of consistent parenting. Thanks. That made me feel awesome. He “prescribed” an over the phone one on one parenting course.

A few months later we finally made it in the next round and started this program focused on positive parenting, with lots of charts and rewards systems for encouraging good behaviour. We had difficulties using many of the tools offered and when that was expressed to our coach, I was repeatedly told “This program is evidence based.”

When the program ended and our little guy kept having these outbursts (though a lot less frequently and less severe), I decided to try another plan of action and took him to a free drop in counselling program I had heard about. After a more thorough discussion with me, the counsellor and my son, it was suggested he had a learning disability. But not your typical reading or math type. He was having troubles learning how to manage disappointments, frustrations and changes in routine. The more I learned, the more I felt it described him to a “T”.

It was frustrating to learn that we had spent that much time and effort (15 weeks!!) in a program that didn’t really address the problem, but as I learned more about his needs, it was clear that that type of parenting program could have the opposite effect. A child with this type of disability can become so focused on the outcome that they ignore the method to get there (behaving appropriately). By setting up charts and rewards systems for good behaviour, you can actually trigger an explosive response when the child doesn’t get the reward at the end.

What this has taught me about evidence based care is that it doesn’t mean shit if it doesn’t apply to your situation. This evidence based program was not designed for us in our circumstances. And so, it was useless (for us). Having someone repeatedly tell me that it would work if I just did it right was degrading, frustrating and made me feel like a bad parent, when I was doing nothing wrong.

Evidence is a collection of information that we look at as a whole. If a treatment works for 80% of people when used correctly, guess what? It doesn’t work for the other 20%. That is a big deal if you are one of the individuals that are the 20%.

Doulas like to tout “evidence based” this and that. I have been guilty of this myself, and may still do it now and again to be honest. Old habits and all that, and I apologize. We do this as if somehow, knowing the evidence is going to change the actual situation. Knowing the evidence that vaginal breech birth is as safe as cesarean delivery for the baby and safer for the mom, does not change the fact that for many women, they do not have access to a provider that will support that. Evidence will not change the mind of a woman who was sexually assaulted and does not want to have a vaginal birth, or breastfeed. And many times, the reasons why are none of our business. Evidence also cannot change a deeply ingrained culture around birth overnight.

Evidence based care is still needed. Having care providers basing recommendations on what is proven to be true is definitely preferable to the alternative. But, it is also important to remember the individual and their situation. And to respect when and if a client is requesting information, or would prefer to not know.

I am committed to learning and offering only evidence based information, but I am working to do so only when requested, and I even better understand now when my clients may choose not to follow it. You know what will and will not work for you better than I do and I fully respect and support your choices.

If you are looking for unbiased and non-judgmental support during your pregnancy and birth, contact The Birth Nerd Kelowna today.

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