Monday, November 09, 2015

The Research Says "this" But Why Doesn't Our Local Hospital Change the Policies? Discovering the Transtheoretical Model of Change.

No one argues the fact that research in birth and breastfeeding changes almost daily.  

New studies with new evidence dispute thoughts long held by many professionals, or validate the thoughts long held by others.  A major conundrum occurs when evidence shows that long held beliefs are no longer valid - especially those beliefs that have impacted hundreds of thousands of expectant families!

Case in point is the new study from the American Society of Anesthesiologists.  In the November 6, 2015 press release, the American Society of Anesthesiologist stated the following:

“Women traditionally have been told to avoid eating or drinking during labor due to concerns they may aspirate, or inhale liquid or food into their lungs, which can cause pneumonia. But advances in anesthesia care means most healthy women are highly unlikely to have this problem today and when researchers reviewed the literature of hundreds of studies on the topic, they determined that withholding food and liquids may be unnecessary for many women in labor.”

Many birth professionals have known anecdotally that aspiration of vomit by a woman with general anesthesia during a cesarean section is virtually non-existent with the increase usage of epidural and spinal anesthesia.

“Researchers also noted that no cases of death due to aspiration were reported in the United Kingdom between 2000 and 2005, compared to 1.5 cases per 1,000 during the 1940s.”

In reading this as a birth professional, many will rejoice that the researched evidence proves the anecdotal evidence.  Others will react more negatively and ask further, “What’s taken everyone so long?”

It is important to realize that the wheels of change move slowly in regular life, and much more slowly in the world of health and medicine.  New concepts or re-evaluated concepts must go through a research based vetting process on the world scale and often on the national and local scale as well. Once the concepts are more accepted, hospitals begin to take a look at them.  Policy changes go through many committees, including an obstetrics section committee. These committees are made up of nurses and physicians and managers, who also have full schedules.  Thus, those wheels of change also move very slowly by the very nature of the schedules of the members of the committees but also the gravity of changing major policies.  Once policies have been changed, implementing change often confuses or disorients some individuals.

The bottom line, change happens very, very slowly.

Another way to look at the reason for slow change is the Transtheoretical Model or Stages of Change developed by psychologists Prochaska and DiClemente in the late 1970s.  The Transtheoretical Model is designed for health promotion and fits perfectly in our scenario regarding offering food in labor.  The different Stages of the Model include:

  1. Precontemplation - In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behavior is problematic or produces negative consequences. People in this stage often underestimate the pros of changing behavior and place too much emphasis on the cons
    of changing behavior.
  2. Contemplation - In this stage, people are intending to start the healthy behavior in the foreseeable future (defined as within the next 6 months). People recognize that their behavior may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behavior takes place, with equal emphasis placed on both. Even with this recognition, people may still feel ambivalent toward changing their behavior.
  3. Preparation (Determination) - In this stage, people are ready to take action within the next 30 days. People start to take small steps toward the behavior change, and they believe changing their behavior can lead to a healthier life.
  4. Action - In this stage, people have recently changed their behavior (defined as within the last 6 months) and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors.
  5. Maintenance - In this stage, people have sustained their behavior change for a while (defined as more than 6 months) and intend to maintain the behavior change going forward. People in this stage work to prevent relapse to earlier stages.
  6. Termination - In this stage, people have no desire to return to their unhealthy behaviors and are sure they will not relapse. Since this is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs.  

It can indeed be frustrating to wait for change to occur.  But, as my grandfather used to say, “the squeaky wheel gets the grease”.  Therefore as dedicated birth professionals, keeping our anecdotally proven concepts in front of researcher and other professional will raise the likelihood of eventual adoption and adaptation.

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