Why I Practice Evidence-Based Midwifery (And Still Respect Your Right to Say No)

I’ve always believed that the best care is rooted in truth and delivered with respect. I also believe pregnancy is a normal state of health.

As a midwife, I rely on evidence. Not anecdotes. Not fear. Not pressure. Evidence.

But just as fiercely, I believe in autonomy. I believe that your body is yours. That your birth is yours. The final say in your care belongs to you, not me. Not to any provider.

That combination, evidence-based care and unwavering respect for your right to say no, isn’t always popular. In fact, I’ve come to realize it’s a bit radical. Especially in a culture that still rewards compliance over collaboration and views informed refusal as a threat instead of a right.

But this is the foundation of my work. It always has been.

With over 700 births behind me, most of them at Holistic Heritage Homebirth, where I attended more than 90% of all births, I’ve seen the incredible, powerful normalcy of birth. Most of the time, things go smoothly. Birth is not a crisis waiting to happen. But occasionally, things don’t go as planned. And that’s exactly why you hire a midwife: not because you expect something to go wrong, but because if it does, you want someone there who knows how to act quickly, calmly, and skillfully.

I’ve had the honor of supporting five families through the unimaginable loss of a stillbirth. None were due to negligence or error, but each was a devastating, sacred moment that I carry with me. I will never gloss over those losses. I can also say, with both humility and deep respect for this work, that there has never been a preventable maternal or neonatal death in my care. When emergencies arise, and they do in every practice, my job is to be ready, not rattled. To act, not panic. That’s what a good midwife brings to the birth room.

I don’t say that to brag. I say it because facts matter. And so do values. And when people misunderstand or misrepresent your work, it’s important to speak clearly and directly about why you do what you do.

So, this article is not a reaction, not a defense, but a clear explanation of what guides my practice and what you can expect when you choose evidence-based and client-led care.

Because I’m not here to control you.
I’m here to inform, support, and walk beside you, with science, skill, and compassion.
And you’ll never be punished here for choosing what’s right for you.

Evidence-Based ≠ Authority-Based

Somewhere along the way, “evidence-based” became a weapon.

I see it in hospitals. I hear it from physicians. I even hear it from other midwives:

• “We don’t allow that.”
• “That’s not evidence-based.”
• “That’s not in our guidelines or standard of care.”
• “The ACOG guideline says…”

However, evidence-based care is not the same as authority-based care.

Following evidence doesn’t mean handing over your decision-making to the provider with the loudest voice or the longest title. It doesn’t mean shutting down the conversation. And it definitely doesn’t mean treating people like problems to manage rather than humans to partner with.

What it should mean is this:

• We look at the best available research.
• We apply our clinical experience.
• And we ensure the care aligns with what the client wants and believes is best for their body and baby.

That’s it. That’s the full definition.

Unfortunately, in many clinical settings, only two of those three get attention: research and provider opinion. The third pillar, patient autonomy, is often treated like an inconvenience or, worse, a liability.

I’ve had clients come to me after being told by other providers that they were “non-compliant” for asking questions. That they were “refusing care” just for declining one recommendation. That they were risking their baby’s life because they said “no” to something they weren’t comfortable with.

This is not evidence-based care. This is coercion, dressed up in clinical language.

When someone says, “This is the evidence, so you have no choice,” they’ve already abandoned the model they claim to follow. Because genuine evidence-based care requires your participation. Your consent. Your voice.

Not just as a courtesy, but as a core component of safe, ethical healthcare.

What Real Evidence-Based Care Looks Like

Let’s be honest, “evidence-based care” sounds straightforward until you actually try to apply it in real life.

• Because the evidence doesn’t always agree.
• Because people are different.
• Because birth isn’t a math problem, it’s a deeply personal experience that unfolds in real time, not in controlled conditions.

So, what does it really mean to offer care that is based on evidence?

For me, it means weaving together three key elements:

• Best available research
• Clinical experience and judgment
• The client’s goals, values, and informed preferences

If one of those is missing, the care is incomplete.

I read studies. I track data. I look at what the research says, not just the conclusions, but how the study was designed, who it included, and its limitations. I don’t just memorize guidelines; I analyze them. And I stay humble about what we still don’t know.

Then I bring my own clinical judgment into the mix. With over 700 births behind me, including breech, twins, VBACs, and complex transports, I’ve seen a wide range of situations unfold. I know how to read labor patterns, pivot when things shift, and keep a cool head when it matters most. That’s not something you get from a textbook. That’s lived expertise.

But the third piece? That’s the one too many providers skip. It’s the one that really defines how I practice.

The client’s voice.

I ask about your values. I ask what’s important to you. I explain what I know in plain, honest terms. And then I respect your decision, even if it’s not the one I would make for myself.

That’s real evidence-based care.

It is not a rigid checklist, not a threat wrapped in science, but a conversation, a collaboration grounded in skill, facts, and trust.

And trust doesn’t come from controlling someone. It comes from honoring them.

Autonomy Is Not the Enemy of Safety

Let’s get something straight: respecting a client’s right to choose does not make care more dangerous.

It’s easy to think it does. I get why some providers are scared. We live in a culture of liability, and patient choice is often treated as a threat. Providers are taught to protect themselves with protocols, policies, and paperwork, not connection, nuance, or trust.

But that fear doesn’t make people safer. It just makes them smaller.

When you strip someone of their ability to say no, silence their instincts, or override their concerns “for safety,” you’re saying: You can only be safe if I’m in control. That’s not care. That’s control. And it undermines everything we know about what makes birth and healthcare in general work well.

I strongly believe that real safety doesn’t come from compliance. It comes from informed, engaged participation.

People make better decisions when they feel heard. They’re more likely to stay in care when they feel respected. They’re more honest when they’re not afraid of being shamed. That’s not idealism, that’s common sense.

Autonomy and safety are not two opposing forces. In my experience, they support each other. When clients are empowered, their choices are honored, and they’re treated like the primary decision-makers in their own care, they’re more likely to make thoughtful, informed, grounded decisions. And that makes everyone safer.

Birth is unpredictable, and emergencies happen. But when they do, the last thing anyone needs is a foundation built on fear and control. What they need is trust, clarity, and a provider who respects them enough to keep them at the center of every decision.

That’s what autonomy actually looks like in practice.
And it’s not the enemy of safety, it’s one of the most powerful tools we have to protect it.

Midwifery, Informed Choice, and the Power of Consent

What drew me to midwifery wasn’t just the science of birth, it was the belief that people deserve to be in charge of their own stories.

That belief still shapes every part of how I practice.

Informed choice isn’t a policy or a permission slip. It’s a relationship. It means I show up with what I know, training, experience, and data, and you show up with what you know, your body, your history, your values. Together, we figure out what’s right for you.

There’s no hierarchy in that model. No one holding all the answers. No one handing down a plan you’re expected to accept without question.

Instead, there’s honesty. There’s trust. And there’s room for you to say, “Yes, I want that,” or, “No, I don’t.” Without fear. Without pressure.

This kind of consent isn’t always flashy. It happens in the quiet moments, when I pause to ask what you’re feeling, or when I give you time to think instead of pushing for a decision. But it matters. It matters so much.

Because when someone leaves their birth knowing they were listened to, respected, and involved, that matters just as much as any clinical outcome. Sometimes more.

And that’s the heart of midwifery for me.

Not just being there when the baby arrives, but being fully present for all the moments leading up to it.
Not just offering choices, but protecting the space where those choices can be made.

That’s the kind of care I believe in.

I demand the same care and respect for the client from everyone who works for me. If they can’t do that, we need to part ways.

What Clients Should Expect from Evidence-Based Providers

If a provider claims to practice evidence-based care, that should mean something.

It should mean more than throwing around the word “research.” It should mean more than sticking to policies or parroting guidelines. And it should absolutely mean more than expecting unquestioning compliance.

So, what should you expect from an evidence-based provider?

• You should expect clear, honest communication.
• You should expect up-to-date information delivered without condescension or pressure.
• You should expect space to think, ask, and weigh your options.
• You should expect time. Not a rushed 12-minute visit, but enough time to actually process what’s happening.
• You should expect transparency. If the evidence is uncertain or evolving, you deserve to know that.
• You should expect a care plan that includes your input, not one handed down from above.
• You should expect to be able to say “no” without punishment or guilt.

That’s not too much to ask. In fact, it’s the bare minimum.

Because at the end of the day, it’s your body. Your baby. Your life.
And any care that claims to be based on evidence must also be based on consent.

Anything less isn’t evidence-based. It’s authority-based, with a scientific mask.

Final Thoughts: Evidence, Autonomy, and Knowing My Limits

I know how overwhelming it can feel to navigate pregnancy in a world full of noise, opinions, protocols, research studies, outdated advice, and unsolicited commentary from every direction.

So let me clarify one thing: I don’t expect my clients to know everything.

My job is to bring the evidence, the training, and the clinical skill to the table.
But I do expect my clients to know themselves.
To trust their intuition.
To ask questions.
To think critically.
To say no when something doesn’t feel right.
And to have a real voice in their care, not just be along for the ride.

I also want to be clear about something else: “safety” isn’t one-size-fits-all.

What’s safe for one provider might not be safe for another. And that’s not a criticism, it’s reality. CNMs, CPMs, LMs, OBs, we all have different training, different scopes of practice, and different tools available to us. A procedure that’s completely appropriate in a hospital setting may be out of reach in a homebirth. Likewise, there are things I’m trained and licensed to do safely as a Certified Nurse Midwife that may fall outside another midwife’s legal or clinical comfort zone.

For example, I would never perform a cesarean or administer an epidural. That’s outside my scope. However, some situations and decisions are within my training and experience that others might not be equipped to handle.

So when people talk about “safety,” we need to be honest about what that really means. Because real safety isn’t a checklist or a policy, it’s contextual. It depends on the provider, the setting, the care model, and the moment.

One of my core beliefs is that safety is shaped by both the provider’s skills, training, and comfort level and the client’s own sense of security. If a client doesn’t feel safe, even in a hospital with every tool on standby, then it’s not truly safe for her. And if a provider isn’t comfortable or competent in a particular situation, that’s not safe either, no matter the setting.

Evidence-based care means being honest about all of this, not pretending that one-size-fits-all. It means holding space for both clinical facts and lived experience. It means respecting the mother’s voice and knowing your own limits as a provider. That’s the kind of midwifery I believe in.

And that nuance matters.

Now, with that said, I also have professional limits. As much as I believe in autonomy, fiercely, fully, and without apology, there are rare times when a client’s decision crosses a line I legally or ethically cannot follow. In those cases, I may have to discontinue care. Not because I don’t respect the choice, but because I have to protect my license, my reputation, and the integrity of my practice.

That doesn’t mean I stop caring. It doesn’t mean I wish anything but the best for that family. It just means I know where my boundaries are, and I honor them.

Because ultimately, evidence-based care and autonomy are not in conflict. They are partners in ethical, respectful, and human-centered care.

If you’ve read my article last week on gossip, you’ve probably sensed that this one is closely related. You’re right. These articles are two sides of the same truth: that integrity matters in our words and in our work. And when your reputation is on the line, the best response isn’t retaliation. It’s transparency.

If what I’ve shared here resonates with you, and you’re looking for evidence-based care grounded in trust and autonomy, I’d love to talk. And if you’re not in my area, I hope this gives you language and clarity as you search for a provider who aligns with your values.

—Stay Strong!  Jaelin—

Additional Reading

• Evidence Based Birth
• Babies Are Not Pizzas: They’re Born, Not Delivered by Rebecca Dekker
• Ina May’s Guide to Childbirth “Updated With New Material” by Ina May Gaskin

About the Author:

Dr. Jaelin Stickels, DPN, CNM, APRN, is a deeply passionate and highly skilled Certified Nurse Midwife and the owner of Holistic Heritage Homebirth in Houston, Texas. With over a decade of midwife experience, Jaelin has had the privilege of helping several hundred (over 700 as of 2024…) women welcome their babies into the world. In addition to her advanced practice licensure training, she has additional advanced training in twin and breech births, making her one of only a few with these skills in her area.  Jaelin approaches every birth with expertise, compassion, and a deep respect for the birthing process.

Jaelin’s journey into midwifery began with a profound love for supporting women through the incredible experience of pregnancy, labor, and postpartum. Since 2010, she has been dedicated to walking alongside families during these transformative moments, offering guidance, support, and care tailored to each individual’s unique needs. She is a big believer in informed consent and ensures clients are given the best evidence-based information to make the best decisions for themselves and their families.

Married to her high school sweetheart Ted (aka Chef Ted) since 1984, Jaelin is the proud mother of three grown children and the delighted grandmother of one amazing granddaughter. When she’s not assisting in births, Jaelin finds joy in going to the movies with her husband, quilting, and cherishing time with her family. Known by the other midwives in her practice (Holistic Heritage Homebirth) affectionately as the “Birth Hog,” she brings an unmatched dedication and enthusiasm to her work—no one loves birth quite like she does.

Read Jaelin’s Bio

Find out more about Jaelin’s Homebirth Practice (Holistic Heritage Homebirth) in Houston, TX