What is evidence-based midwifery?


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This is a slideshow that talks about evidence-based practice in relation to midwives and midwifery practice.

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  • Welcomes Clarify who should be in class Paper outline and assessment– go through, text book of readings. Ask What do we mean by evidence based midwifery practice? Brainstorm onto whiteboard Why the move towards EBMP? Next slide…
  • What is evidence-based midwifery?

    1. 1. Evidence based midwifery practice Sarah Stewart [email_address] http://sarah-stewart.blogspot.com
    2. 2. http://www.youtube.com/watch?v=OeA_OKqqBJ4 Why EBM?
    3. 3. How would you define EBP? <ul><li>Identify key words – </li></ul><ul><li>word cloud </li></ul><ul><li>http://www.wordle.net </li></ul>
    4. 4. Definition <ul><li>It is about using research rather than doing it. </li></ul><ul><li>It is a movement away from always doing things in the way in which we were taught and from decisions based on personal opinion. </li></ul><ul><li>It requires that we look for and appraise research evidence to inform decisions about tests, treatments, patterns of practice, and policy (Page, 2000). </li></ul>
    5. 5. Why use evidence? Image: ' Savage walk: don9t ask, just go ' www.flickr.com/photos/61787893@N00/275371357
    6. 6. Ritual, habit and routine Image: ' through the tollbooth.... again ' www.flickr.com/photos/44124472651@N01/345154087
    7. 7. EVIDENCE vs RITUAL HABIT ROUTINE Image: ' Dusting for prints. ' www.flickr.com/photos/36521968006@N01/246535658
    8. 8. <ul><li>In pairs think about your own midwifery practice. Are there any practices and/or interventions that are being carried out during the childbearing phase despite you knowing that they are not based on evidence? Can you list some? </li></ul><ul><li>Now think about why the practice or intervention has not changed. </li></ul>
    9. 9. Asking and Formulating Answerable Questions <ul><li>What’s got four legs, one wheel and flies </li></ul><ul><li>A dead sheep in a wheelbarrow </li></ul>
    10. 10. PICOT FRAMEWORK (Jackson, 2006) <ul><li>Five parts to well-built clinical questions: </li></ul><ul><ul><li>Participants (client group/problem) </li></ul></ul><ul><ul><li>Intervention </li></ul></ul><ul><ul><li>Comparison (there is always an alternative) </li></ul></ul><ul><ul><li>Outcome </li></ul></ul><ul><ul><li>Timeframe </li></ul></ul>Image: ' picot socks ' www.flickr.com/photos/60576152@N00/419127278
    11. 11. Example of a Formulated PICOT Question <ul><li>In a woman with a normal pregnancy and severe cramps in her leg at night, is extra calcium likely to help, and are there likely to be any </li></ul><ul><li>side-effects </li></ul><ul><li>from the extra </li></ul><ul><li>calcium? </li></ul>Image: ' who are you? ' www.flickr.com/photos/60012221@N00/107729240
    12. 12. The question can be broken down into PICOT:- <ul><li>P articipants = woman with normal pregnancy </li></ul><ul><li>I ntervention = is calcium likely to help? </li></ul><ul><li>C omparison = compared with exercise only </li></ul><ul><li>O utcome = the reduction of leg cramps </li></ul><ul><li>T imeframe = during pregnancy </li></ul>
    13. 13. Formulating a Question <ul><li>Use the PICOT Framework to write a question to guide your search for evidence. </li></ul><ul><li>In pairs, formulate a question using the following scenario. </li></ul>
    14. 14. Clinical Scenario <ul><li>Ms Wax is approaching term. She has prepared a birth plan indicating that she wishes to avoid intervention in labour. At her 39 weeks visit, the fundal height is 39 cm, the fetus is active, her blood pressure is 120/85, and there is no protein in the urine. At this visit, Ms Wax wonders whether it is enough to listen to the fetal heart regularly or whether she should think about having continuous electronic monitoring. </li></ul>
    15. 15. <ul><li>Participants </li></ul><ul><ul><li>How would I describe a group of clients/women like mine? </li></ul></ul><ul><li>Intervention </li></ul><ul><ul><li>Which main intervention am I considering? </li></ul></ul><ul><li>Comparison </li></ul><ul><ul><li>What is the main alternative to compare with the intervention? </li></ul></ul><ul><li>Outcome </li></ul><ul><ul><li>What does this intervention effect? </li></ul></ul><ul><li>Time </li></ul>
    16. 16. Levels of evidence <ul><li>What do you think this means? </li></ul><ul><li>What types of evidence are there? </li></ul>http://pixton.com/comic/idp0q5kr
    17. 17. Professional consensus <ul><li>Guidelines from expert groups </li></ul><ul><li>Paradox that EBP increases our uncertainty </li></ul><ul><li>How would you define an expert? </li></ul>Image: ' Trust us, we9re expert ' www.flickr.com/photos/35034348187@N01/35555985
    18. 18. Guidelines http://www.nzgg.org.nz/guidelines/dsp_guideline_popup.cfm?guidelineCatID=26&guidelineID=74
    19. 19. Barriers to implementing EBM Image: ' Thames Barrier ' www.flickr.com/photos/16377475@N00/64248038
    20. 20. Strategies for developing ‘best practice’ Image: ' No retreat, no surrender ' www.flickr.com/photos/16189905@N00/309451530
    21. 21. EBP and midwifery professionalism Image: ' 6lbs 9oz ' www.flickr.com/photos/44124365893@N01/91692347
    22. 22. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials Gordon & Pell, 2004.
    23. 23. References <ul><li>GRADE Working group. (2004). Grading quality of evidence and strength of recommendations. BMJ, 328, 1490- 1494. </li></ul><ul><li>Hamer, S. (1999). Evidence-based practice. In S. Hamer & G. Collinson. (Eds.). Achieving evidence based practice (pp3-12). London: Harcourt. </li></ul><ul><li>Jackson, R., Ameratunga S., Broad, J., Connor, J., Lethaby, A. & Robb, G. (2006). The GATE frame: critical appraisal with pictures. Evidence Based Medicine, 11, 35-38 </li></ul><ul><li>Munro, J. & Spiby, H. (2000). Guidelines for midwifery-led care in labour. Retrieved 22rd November, 2008, from http://www.aamatronas.org/vidocs/protocoloshefield.pdf </li></ul><ul><li>Page, L. (2000). Using evidence to inform practice. In L. Page (Ed.). The New Midwifery: Science and sensitivity (45- 70). Edinburgh: Churchill Livingstone. </li></ul><ul><li>SIGN. (2000). Grading system for recommendations in evidence based clinical guidelines. Scotland: SIGN. </li></ul><ul><li>Spiby, H. & Munro, J. (2001). Evidence into practice for midwifery-led care. British Journal of Midwifery, 9, (9), 550-552. </li></ul>