evidence-informed midwifery
sara wickham
While many people out there are busily working on
the scientific quantitative research evidence which
evaluates the practice of midwifery and obstetrics,
I would argue that this is only one form of knowledge
used by women and midwives in making decisions about birth.
I feel there are three main issues which can be
addressed through the use of evidence-informed midwifery.
The first of these is concerned with the fact that midwives
support women making decisions. And women come to midwives
because they need knowledge on which to base these decisions.
The more we can generate for ourselves in the way of
knowledge and understanding of women's bodies, the more we
can help those women and their babies to make the
decisions which are right for them. We need to become
more inclusive about the forms of evidence which
we seek to understand and develop and which can
provide the information needed by women.
We are in danger of losing those forms of evidence
and ways of knowing which are unique to women,
and which may be the most relevant to the ways we work together.
While some of the ideas we have may not be mainstream at
present, embracing and utilising the concept of evidence-informed
midwifery may be one way in which we can make them so.
The question of how we can validate midwifery knowledge
is one of the most exciting 'hot topics' right now.
Having worked with midwifery research for a number
of years, I am aware that analysis of this research points
to the very things that we do know in our hearts; that birth
is a sacrament which is 'as safe as life gets'. Yet we live in
a society where women are taught to distrust their bodies and
the process of birth, turning instead to doctors and technology.
We need to enable women to understand that, for the majority
of people, even scientific research shows that home birth
and midwifery are safer than the alternatives. For me,
promoting evidence-informed practice is a way to ensure
that more women and babies get safe, effective, loving
midwifery care which empowers them as people and parents.
The whole area of evidence-informed midwifery raises
far more questions than answers at present.
Having established that we may need to be more inclusive
of what we define as 'evidence', we need to address the
issue of validity - how do we, as individual midwives,
evaluate any particular form of evidence? The process
that we use to evaluate research is well-understood.
But how do we ensure that we are using our experiential
knowledge appropriately? How can we justify using intuitive
ways of knowing - not even necessarily for ourselves, or for
the women we work with, but for women who have learned
not to trust their feelings or for other practitioners who
may choose to incorporate this into their practice?
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More articles on evidence-informed midwifery...
The Midwifery Today Series...
Evidence-informed midwifery 1: what is evidence-informed midwifery?
Evidence-informed midwifery 2: using research in midwifery practice
Evidence-informed midwifery 3: evaluating midwifery evidence
Coming Soon...
Seeing Women in the Numbers
(see MIDIRS Midwifery Digest December 2003)