Midwives essential in research


Midwives cater for millions of women through pregnancy, labour and care for their newborn, making midwifery is an essential part of healthcare. However, not much of the research surrounding the specialty is undertaken by midwives themselves. A correspondent for OGMN, a consultant in obstetrics and gynaecology, urges midwives to be undeterred and unafraid to partake in studies to advance midwifery.

 

Introduction

A  careful read through a very incisive commentary by Luyben et al1 sets the tone for a valuable observation on an important issue: the need for more input from midwives in research. As the people who underpin the process from pregnancy to breastfeeding, midwives’ experience is invaluable when it comes to better understanding and advancing knowledge and understanding of labour. Luyben et al point out that the involvement in research by midwives that they observed was in response to demands from consumers and healthcare providers, and followed a nudge by the International Confederation of Midwives (ICM).

A Scientific Research and Training group was founded by Dutch midwives in 1990, who created courses in training with an epidemiological perspective. In Austria, midwives have collaborated in research related to postpartum depression, healthcare engineering and development of a computer software for postnatal care. The Swiss Network of Midwifery Research was established in 1994, and it set its agenda using survey on factors influencing research in German-speaking regions.

The sobering finding was that only 13 percent of respondents believed that doctors would allow the implementation of research by the Swiss Network of Midwifery Research in practice. This underlined the extent to which physicians dominated the policies and practices of maternity care.

German midwifery research has gone further to explore and develop interventions in labour, antenatal care guidelines and out-of-hospital births. It is pointed out that the midwifery literature service (Hebammenliteraturdienst or HeLiDi), a four-page, six-monthly add-on of new research findings was modelled after the British Midwives Information and Resources Service (MIDIRS).

 

Time for a change

Regular information dissemination of research findings and research possibilities are an important bedrock upon which a research culture develops and thrives. The authors conclude that midwifery research in Germany, Austria, Switzerland and the Netherlands was developed as a context-specific paradigm, and it may require the creation of university departments. Midwifery research should also go hand-in-hand with more efficient dissemination of research needs, findings and opportunities for involvement even at the most basic level.

One recent study which illustrates the role of midwives in research and having patient needs at the core was undertaken in a tertiary-care hospital in Basel, Austria.2 Acupuncture therapy was administered by midwives, the needles placed at points such as the perineum, hands or head for durations of between 20 and 30 minutes to test women’s response to this type of treatment. The indications included cervical dystocia, induction of labour and retained placenta. The post-experience interviews were transcribed verbatim and subjected to thematic analysis. This study was solely undertaken by midwives.

 

Midwives in the know

It appears that British Midwives have set the bar rather high, at least for certain categories of research. For example, on its website (www.doctoralmidwiferysociety.org), this group appears to be the purveyors of evidence-based midwifery, and its publication, highlighting links to funding opportunities, Wellbeing Of Women/RCM/BMFMS scholarships and the 8th International Normal Birth Research Conference.

However, membership (amongst other things) appears to be somewhat aimed at midwives who ‘hold a doctoral degree or are currently studying towards’ one. This may deter some midwives from contributing their expertise to research, but this should not be the case.

Most Research Midwives in the UK do not possess a PhD, yet they are critical to most on-going clinical research in maternity care today. An audit of a 21-bed birthing unit enabled midwives to specify areas of interest they may wish to further investigate, and to engage in quality assurance follow-up tasks.3

The audit tool was the RCOG Standards of Maternity Care (2008) from which 23/30 criteria were assessed. Criteria for 21 standards were met. The authors conclude that the audit experience may be used by staff as a motivation to ensure reflective practice, to respond to patients’ needs, and to engage in quality assurance.

An audit is an aspect of research either as a concept-generating tool, or as a long-term surveillance of primary conclusions of clinical research. There are few, if any studies, which have compared patient satisfaction between obstetric triage units, which traditionally initially have patients examined by registered nurse before asking a nurse-midwife, and a newer model where the certified nurse-midwives saw patients directly.

One study carried out by members of The American College of Nurse Midwives (Paul et al) showed that the later model reduced length of time in the unit from a mean of 66.8 minutes to 50.1 minutes.4 One unfamiliar term to clinical care providers, but not so to midwives, is ‘therapeutic presence’. It is documented in this study as a captured theme from the qualitative data. Unfortunately a summative table, as is presented in the study, does not allow a full appreciation of the need of therapeutic presence. However, the authors do discuss the implications of time-saving on cost-saving, faster bed turnover and overall training.

 

Empowering midwives

Operational research may as well be the new direction for the next decade as healthcare organisations strive to maximise efficiency and upgrade staff capability to acquiring added-on skills, and midwives should endeavour to be part of this research.

Mention must be made of the recent Nottingham International Conference for Education in Midwifery, held on the 7th and 8th September, 2012. There were concurrent sessions on topics that spanned from e-learning to curriculum development and innovation, and from professional development to organisational strategies.

The virtual maternity unit, developed by the University of Nottingham’s island was displayed. A salutary presentation on appraisal of the two-year running Midwifery degree at Griffith’s University in Australia revealed that the graduates expressed surprise that they did enjoy the course, which was based on teaching an appreciation of evidence-based practice and research.

Finally, New Zealand Midwives Research Forum appear unparalleled in their set goals for research. This would appear to be a benchmark against which other similar bodies should assess their performance. It aims to, and currently does:

  • Provide liaison between the various pre-registration and post-registration midwifery education institutions to maintain an active and up-to-date database of midwifery student research activities
  • Develop and maintain a national database of completed midwifery research in New Zealand
  • Promote collaboration and facilitate liaison between midwifery researchers
  • Promote and facilitate collaborative multi-disciplinary research projects between midwives and other organisations such as consumers, healthcare service providers and educational institutions
  • Develop and maintain a database of midwives qualified to supervise research and examine research at postgraduate level
  • Provide advice to NZCOM on research matters
  • Provide advice to midwife researchers on research issues and preparation of reports for publication in NZCOM Journal
  • Develop resources for midwife researchers in relation to sources of research funding
  • Collaborate with NZCOM to run a biennial National Research Forum to support and promote postgraduate midwifery researchers, to develop expertise, to support a research culture in DHBs and to provide a forum for developing robust research
  • Collaborate with NZCOM to continue development of the midwifery reference library as a resource for midwives
  • Identify research needs for midwifery and maternity in New Zealand and encourage researchers to undertake these projects
  • Advise on or manage NZCOM research grants
  • Employ researchers and undertake research projects on behalf of NZCOM
  • Make funding applications
  • Undertake contract work in relation to research or audit projects for other agencies
  • Facilitate collaborative international midwifery research

Now, can we beat that? Watch this space.

 

References

  1. Luyben AG, Wijnen HAA, Oblasser C, Perrenoud P, Gross MM. The current state of midwifery and development of midwifery research in four European countries. Midwifery(2013) 29: 417-424
  2. Gisin M, Poat A, Fierz K, Frei IA. Women’s experiences of acupuncture during labour. British Journal of Midwifery(2013) 21(4) 255-262
  3. van Uden A, Freeman L. Assessing quality care-the beginning of the journey. New Zealand Audit. New Zealand College of Midwives (2011) 45: 10-15
  4. Paul J, Jordan R, Duty S, Engstrom JL. Improving satisfaction with care and reducing length of stay in an obstetric triage unit using a Nurse-Midwife-managed model of care. Journal of Midwifery & Womens’ Health(2013) 58: 175-181
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