Monday, April 23, 2012

Studies, Practice Changes and Evidence….OH MY!

When studying statistical data in most medical professions, it is generally accepted that studies have an expiration date.  That is, if a study is older than three or five years, the data is seen as invalid.  The study is too old, times have changed, practices have changed. 

Yet some studies done with the human body, such as labor and birth, may be valid regardless of the date.  Why?  Because depending on the parameters of the study, the subject matter does not change.  The human body does not evolve that quickly to make a study in 1965, for example, out of date.  What may change is the method by which data is discovered – technology changes and thus the data may change. For example, with childbirth education, many of the studies done at the dawn of the natural childbirth movement in the 1960s are still valid today, the parameters are different and if redone, the newer study would include web access and online learning.  The basics may still be applicable.

When discussing evidence-based medicine, the evidence must be current.   US organizations such as ANA (American Nurses Association) , AWHONN (Association of Womens Health Obstetrics and Neonatal Nursing) , ACNM (American College of Nurse Midwives) or ACOG (American College of Obstetricians and Gynecologists)  are charged with the duty to present to their members with the most current practicing standards for creating best practice.  These standards are a compilation of leading edge knowledge/research to be used in the creation or revision of policies, procedures, practice guidelines and also as clinical benchmarks.  Basically, it helps everyone practice from the same playbook.

Gaining evidence is so easy in our technological world.  Just searching for MEDLINE, Cochrane, MIDIRS, Pubmed or CINAHL can provide not only current evidence based information on a topic but in some instances, a historical prospective as well.  Understanding our past and knowing our present helps to provide care that makes a difference.  In these databases, one can also find information from other countries.  While some medical professionals may see evidence from other countries as not applicable to the US due to a variety of confounding factors, the data does give one cause to pause particularly if the country cited has a significantly different maternal morbidity/mortality or infant morbidity/mortality than the US.
Education-based professionals such as childbirth educators, lactation consultants and doulas need only to look at studies and dissect them, putting them in lay terms and put them in the hands of expectant and new parents.  In order to have full informed consent, parents need to have the correct information, not what is geographically traditional or “the way we’ve always done it”.  The birth professional, too, is accountable in learning the most current information ~ with the accessibility to the internet, the excuse of “I haven’t heard about that” begins to pale.  A great first step would be to read through information from Childbirth Connection

Let’s take breastfeeding for example.  There are multiple resources by just typing in the word breastfeeding into a search engine.  The Surgeon General’s Call to Action is one of the very first pages to come up.  Stuffed full of evidence based research, this is an important read for any perinatal care provider.  Why peri natal care provider?  Because peri indicates the entire spectrum of the childbearing year – if we think that birthing practices or newborn care practices do not impact breastfeeding, think again!  Important to know about also are the HealthyPeople 2020 Objectives for Maternal, Infant and Child.  While many are repeated from 2010 (because the US didn’t meet the goals by 2010), some others have been added.

The evidence for best practice is available.  The next blog will focus on why it takes so long for change to happen and how you might be able to become a catalyst for change in your community.

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