Although Rebecca De Young Dekker ’02 has made her research name through noted work on heart disease and depression, her first birthing experience inspired a second area of medical interest: evidence-based birthing.
“I’ll have to be creative in the future if I am to combine my two interests,” said Dekker, an assistant professor of nursing at the University of Kentucky. “I’m exploring some issues related to pregnant women who are at risk for cardiovascular disease. We have a great team of researchers on our heart team and perhaps we can mix in some maternity care.”
Dekker’s first daughter, Clara, was born in 2008 and despite being well-trained as a nurse and medical lecturer and researcher, she was unprepared for the fact that in the United States, evidence-based care was not being practiced in many labor and delivery units.
She assumed that most of the things she was asked to do as a birthing mother were necessary, but some of the things she was “not allowed to do” or “must do” during childbirth puzzled her, and subsequent research confirmed her suspicions.
“Since I have access to medical journals, I followed up on my concerns and was shocked,” Dekker said. “Many aspects in the hospital birthing process today are not based on any medical evidence; in fact, some of the things done to women during labor and delivery are actually harmful.”
One example that she found is the common practice of continuous electronic monitoring during the birthing process. Not only is this procedure often uncomfortable for the mother, but repeated medical trials have shown that there is no advantage in outcomes and that it doubles the risk of C-section compared to intermittent monitoring with a handheld monitor.
“There is clear documentation of a 99.8 percent false-positive rate on these machines, leading to added stress for the birthing mother and unnecessary C-sections,” she said. “I wonder if our culture is so used to technology that, even when proved unhelpful or even harmful, it is too late for us to change because we’re used to it and we see it as managing risk.”
Dekker made a list of everything that happened to her during her birth experience and systematically checked each item, summarizing what she found using the highest quality research available. Some doctors who knew of her interest asked Dekker to share the findings with them so they could review their practices.
It occurred to her that other people would like to have access to this information, so she started a blog on a whim: EvidenceBasedBirth.com. Since then, Dekker has joined the board of a new mothers’ advocacy organization, Improving Birth. These are personal pursuits that are not related to Dekker’s role as a faculty member.
“All of this grew into something I never expected,” said Dekker. “Traffic to the blog grew more than 3,500 percent in one year.”
It turns out that no one had blogged about evidence-based practice in the birthing process before, although evidence-based health care has been increasingly discussed and practiced in other health care areas since 1993.
“Evidence-based practice is difficult to implement, but especially in maternity care,” she explained. “There’s little time for care providers to read and study these issues, plus tradition is a powerful obstacle. On top of all this, fear of being sued looms as a major concern for practitioners and health organizations.”
Dekker has made it a personal emphasis to get health professionals to use evidence-based practices by getting information out of the medical journals and directly in the hands of the public. She believes all patients ought to ask, “Can you show me the research evidence?” for a medical course of action.
“I don’t want patients to go rogue,” Dekker added. “I emphasize that patients ought to talk things through with their health care provider. I want people empowered, but you need the expertise of health providers, too. I want people to trust in caregivers, but I also want caregivers to be trustworthy.”
Her primary research area, looking at treating depression in heart patients to improve outcomes, began to interest her in her first job after a Calvin degree—in a cardiovascular unit at Spectrum Health in Grand Rapids.
In her faculty role, Dekker is engaged in research to determine if nurses trained in providing counseling for depression can help improve that condition—which in turn can improve the recovery of those affected by heart disease.
“I’m inspired to make a difference—that’s a core value of mine. Teaching, blogging, researching, it is all very fulfilling. God has come through for me, every step of the journey,” she said.
Additionally fulfilling is life with husband Dan ’03 and children Clara and Henry. By the way, a midwife assisted with Henry’s home birth and will hopefully catch their third baby, due this fall.
