Evidence-based Midwifery Care - Literature review Example

Evidence-based Midwifery Care: Literature Review Introduction: The profession of midwifery has a significant role to play in healthcare industry. The primary responsibilities of midwives include offering care to childbearing women during pregnancy, labor and birth as well as to the newborn while assisting the mother with breastfeeding. In general terms, midwives are autonomous nurse practitioners with expertise in low-risk pregnancy, childbirth and postpartum. Midwives are also trained to handle certain complicated situations including breech births, twin births, and births where the baby is in a posterior position. Therefore, the functionalities of midwives are essential in healthcare. When it comes to describing the notion of evidence-based midwifery, it involves the use of research evidences in order to inform decisions about tests, treatments, patterns of practice and policy. Evidence-based nursing and midwifery practice is concerned specifically with the health of women and children while contributing largely to cost-effective healthcare. The understanding of ‘evidence-based midwifery practice’ includes a number of terms such as evidence translation, evidence transfer, and evidence utilization. In other words, evidence-based healthcare practice involves development of appropriate methods for conducting systematic reviews and analyses, collecting information globally, and finally, for promoting clinical cost-effective healthcare. This paper attempts to briefly address the concept of evidence-based midwifery care. The paper is mainly divided into two parts. In the first part, it will precisely look into the various definitions of evidence-based midwifery care, and discuss the concept in details. In the second part, the paper will make a short but comprehensive literature review on evidence-based midwifery care, especially on the topic of cascade of interventions following induction for post-dates. Part 1: Defining evidence-based midwifery care As mentioned earlier in the introduction of this paper, evidence-based midwifery care involves active research contributing significantly to resolving complicating situations and unhelpful interventions in common nursing practice. The term ‘evidence-based midwifery’ offers a large number of definitions from different medical experts and researchers. Before coming to defining the concept, it is important to note that the meaning of the term ‘evidence’ contains its own share of considerable ambiguity among researchers. For instance, Spiby and Munro (2010) cite Walsh and Stewart stating that the concept of evidence is defined at a basic level denoting as “facts intended for use in support of a conclusion”. So the term ‘evidence-based practice’ in medical science is defined generally as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” (Spiby and Munro, 2010, p. 2). While explaining the ‘best’ evidences, the definition here refers to empirical observation for constituting the most potential evidences for decision making. Spiby and Munro further discuss two types of evidence-based practice: context-free and context-sensitive evidence practice. In both cases, investigation is conducted on what might work how in ideal and specific circumstances. As Page and McCandlish (2006) define, evidence-based midwifery is “a process of involving women in making decisions about their care and of finding and weighing up information to help make those decisions.” This information can be drawn from various individual needs and, values of the woman and her family including information taken from the clinical examination as well as from the evidence about treatments, place of care, and forms of support. Evidence-based midwifery is concerned with the physical safety and personal integrity of the mother, baby and the entire family. Page and McCandlish discuss five main steps to be taken to practice evidence-based midwifery. These steps are (p. 360): Finding out what is important to the woman and her family Using information from the clinical examination Seeking and assessing evidence to inform decisions Talking it through Reflecting on outcomes, feelings and consequences Evidence-based practice is generally considered as a key component for quality midwifery practice. Exploring the history of evidence-based practice, it is believed to have developed in association with problem-based learning or enquiry-based learning. That is to say, in problem-based learning, healthcare decisions and clinical care are based directly on identifiable sources of evidence open to critical appraisal. This further includes the concept of knowledge as the latter is involved in that evidence. In other words, evidence-based practice can be labeled as practice based on knowledge. Now, understanding the term ‘evidence’ under this broad definition, it can be argued that evidence-based practice includes personal experience from life and midwifery, traditional as well as professional knowledge derived from experts and from scientific and technological information. In a broad sense, evidence-based practice can also be associated with the knowledge of a wide range of fields including psychology, sociology, physiology, information technology, and so on. Systematic research is essential in evidence-based practice. Because evidence-based practice involves integrating individual clinical expertise with the best available external clinical evidence from systematic research. In this context, various types of evidence-based literature are significant to note. Following types can be observed in evidence-based literature: Systematic reviews of literature Guidelines and protocols directing the research Major trials In a more technical terminology, evidence-based practice can be defined as a standard framework for clinical practice that incorporates the best available scientific evidence with the expertise of clinical evidence along with the patient’s preferences and values to make decisions about healthcare. An evidence-based approach is necessary in teaching the students of nursing as it helps them incorporating the following key points (Levin and Feldman, 2006, p. 6): Ask clinical questions that can be answered through research and other evidence sources Find the best evidence to answer these clinical questions Appraise the validity of the evidence to support answers to clinical questions Integrate the evidence with clinical expertise and patients’ perspectives Evaluate the effectiveness of carrying out all of the above With the medicalization of childbirth, the importance of midwifery care has become increasingly apparent. The most important and basic point in evidence-based midwifery care is that midwifery is first and foremost about caring for women. Therefore, the most fundamental objective of an evidence-based nursing practice should be directed at providing the woman with adequate care meeting her expressed needs. Moreover, the practice should not be limited by the midwife’s personal or professional philosophy of care; it has to be incorporated with appropriate amount of research based on scientific and clinical evidence. Although the concept of evidence has been discussed and researched by critics differently, the significance of clinical evidence in midwifery care can not be ignored. Evidence-based research can be both quantitative and qualitative as both are required to provide better healthcare services to women in childbirth. Depending on the various medical situations in pregnancy and childbirth, evidence-based midwifery care can be provided with the best available clinical evidence, women’s preferences and common sense. In order to understand evidence-based midwifery, it is important to go through a brief review literature on the subject. Part 2: Review literature on cascade of interventions When it comes to maternity situations, unintended consequences relatively occur in most cases. Many maternity interventions have unintended effects, especially during labor and birth. These interventions usually tend to follow a chain of complicacies since the medicalization of childbirth itself is a complicated issue. In the context of pregnancy and childbirth care, often these unintended effects tend to become new problems that are resolved with further interventions, which may in turn create yet another set of problems. This chain of complications is known as the ‘cascade of intervention’. Mander (2007) explains this cascade of interventions in specific medical terms: the phenomenon of cascade of intervention is “associated with an intervention, such as the partograph, altering the progress of labor from physiological route. To resolve these alterations pharmacological interventions are introduced to augment labor and/or control pain. Oxytocic drugs to augment labor are associated with fetal hypoxia, identified as fetal distress, for which interventions to expedite the birth, such as assistance with obstetric forceps or even caesarean section, may be deemed necessary” (p. 16-17) The series of interventions follows in many ways. One of the common problems causing induction of labor is post-date pregnancy. Induction is generally known as a method of artificially or prematurely stimulating childbirth in a woman. Common causes resulting in labor induction are: Postdate pregnancy Intrauterine fetal growth retardation Health risks during pregnancy Premature rupture of the membranes Premature termination of pregnancy or abortion Scheduling issues Fetal death in utero The most frequent indication for an induction of labor is postdate pregnancy. Postdate or post-term pregnancy takes place when pregnancy crosses 41 weeks of gestation. There are several terms to define post-mature birth, such as post-term, post maturity, prolonged pregnancy and postdate pregnancy. In any case, there is a serious amount of risk associated with the induction of labor. If such induction cases cause complications during labor, the most common method is to conduct a caesarean section. Pairman et al (2006) discuss the prerequisites for induction in order to make sure that the woman in childbirth is properly taken care of. They categorize the following points as criteria to be met for induction (p. 701): Documented evidence of the case, risks and benefits associated with the induction of labor Documented evidence of the indication for induction and the presence of contradictions if any Confirmation of parity Confirmation of gestational age Documented assessment of cervical favorability, fetal position, and presentation and relationship of the fetal head to the pelvic brim Assessment of membrane status Recording of fetal heart rate Routine use of interventions following postdate pregnancy is common in many countries. Pairman et al (2006) makes an exhaustive study of the subject with a number of case studies observed in Australia and New Zealand. These interventions include electronic fetal monitoring, epidurals, oxytocin, episiotomies, instrumental birth with either forceps or vacuum, and caesarean section. It is important to note here that an evidence-based approach is significant in order to guide practice on a number of interventions during pregnancy, labor and childbirth. The case studies reveal that the rate of caesarean delivery is continuously rising in Australia, New Zealand and the rest of the industrialized world. Evidence shows that elective caesarean delivery is increasingly chosen by healthcare professionals and women in these regions. Bringing further the issue of caesarean delivery, Mander (2007) discusses the possible complications related to interventions such as caesarean section. In order to understand the complications of postdate pregnancy or a caesarean delivery, evidence-based research is essential. Most importantly, research shold be undertaken “with women, not on women” (p. 23). Mander classifies a number of ethical issues relating to evidence-based caesarean research including factors like a) the geographical location, b) the researcher’s discipline (rules and protocols), c) researcher’s personal experience, d) timing of data collection, and so on. These factors are important for an evidence-based practice. Further, Mander also points out the following clinical criteria to be used to classify caesarean research: Immediate threat to life of mother and/or fetus Severe fetal and/or maternal compromise, but not life threatening Compromise responding to therapy, but the underlying problem persists Needing delivery, but no compromise is present Can be booked on an elective list The conflicts surrounding the interventions of postdate pregnancy require serious observation with regard to the issue of communication and sharing of information among the women in labor and the practitioners. The use of technology is another important factor contributing to the adequacy of the information-providing process (Churchill, 1997). Moreover, socio-economic factors largely influence the flexibility in caesarean section rates (for instance, in the United States, hierarchy in socio-economic groupings directly influence caesarean section rates). Churchill’s study finds out that “countries with some of the lowest perinatal mortality rates in the world have caesarean section rates of less than 10 percent.” (p. 65) Although the rate of caesarean is highest in the Americas, it is significant that rising caesarean section rates are an international phenomena. Conclusion: With the medicalization of childbirth becoming more and more complicated, it is important to realize that evidence-based practice is a standard tool for assessing clinical evidence as well as other related factors. Apart from clinical factors, socio-economic factors are equally important in decision making with regard to complicacies such as interventions of postdate pregnancy or caesarean delivery. With the increasing rate of caesarean delivery across the world, the responsibilities of midwifery care have become more critical. In this context, the role of information is very significant. Therefore, it is important to focus on the use of technology in making communication better between the woman in labor and the practitioners. Above all, the health of the woman is the first and foremost objective of healthcare. References: 1. Churchill, H. (1997). Caesarean Birth: Experience, Practice and History. London: Elsevier. 2. Davis-Floyd, R. and Sargent, C. F. (1997). Childbirth and Authoritative Knowledge: Cross-cultural Perspectives. California: University of California Press. 3. DiCenso, A., Guyatt, G. and Ciliska, D. (2005). Evidence-based Nursing: A Guide to Clinical Practice. New York: Elsevier. 4. Hall, J. (2001). Midwifery, Mind and Spirit: Emerging Issues of Care. London: Elsevier. 5. Henderson, C. and Jones, K. (Eds.). (1997). Essential Midwifery. London: Elsevier. 6. Kent, B. and McCormack, B. (Eds.). (2010). Clinical Context for Evidence-based Practice. Sussex: Wiley. 7. Levin, R. F. and Feldman, H. R. (Eds.). (2006). Teaching Evidence-based Practice in Nursing. New York: Springer. 8. Mander, R. (2004). Men and Maternity. London: Routledge. 9. Mander, R. (2007). Caesarean: Just another Way of Birth? Oxon: Routledge. 10. Page, L. A. and McCandlish, R. (2006). The New Midwifery: Science and Sensitivity in Practice. Philadelphia: Elsevier. 11. Pairman, S., Pincombe, J., Thorogood, C., and Tracy, S. K. (Eds.). (2006). Midwifery: Preparation for Practice. Marrickville, NSW: Elsevier. 12. Rooks, J. (1997). Midwifery and Childbirth in America. Philadelphia: Temple University Press. 13. Spiby, H. and Munro, J. (Eds.). (2010). Evidence Based Midwifery: Applications in Context. Sussex: Wiley-Blackwell. 14. Tharpe, N. (2006). Clinical Practice Guidelines for Midwifery and Women’s Health. Ontario: Jones and Bartlett. 15. Van Teijlingen, E., Lowis, G., McCaffery, P. and Porter, M. (Eds.). (2004). Midwifery and the Medicalization of Childbirth: Comparative Perspectives. New York: Nova. 16. Walsh, D. and Downe, S. (Eds.). (2010). Essential Midwifery Practice: Intrapartum Care. Sussex: Wiley. Read More