Using research in midwifery

Discuss the importance of research within midwifery, both in terms of appreciating and evaluating available papers and how the evidence is applied to practice. Pressure has increased on health care professionals, via government directives such as the National Health Service Plan (DOH 2002) and Fitness for Practice (UKCC 1999), to provide evidence based care. These directives are aimed at improving outcomes, reducing health inequalities and increasing client satisfaction (Page, 1996). Making a Difference (DOH 1999) states that ?Further research activity and systematic review within midwifery are essential to underpin both education provision and practice development. Such work will provide a strong ethos of enquiry within midwifery and facilitate a robust approach to both quantitative and qualitative research?. The Nursing and Midwifery Council (2002) Code of Professional Conduct informs of the responsibility of midwives to ?deliver care based on current evidence?.For the purpose of this essay and in order to discuss research methods and relevance to practice more succinctly, a specific topic has been chosen for investigation. The subject is that of caseloading or one-to-one midwifery, where, as defined by Page et al (2000), a midwife will be responsible for and provide most of the care for a woman and her family for the duration of her pregnancy and into the puerperium. This subject has great relevance to practice. The provision of maternity care has undergone many changes since the middle of the last century.

The 1946 National Health Act initiated the institutionalisation of childbirth and various consecutive government reports encouraged hospital based maternity care with improved outcomes supporting the belief that childbirth was dangerous (Audit Commission, 1997). Walton and Hamilton (1995), highlighted the dissatisfaction of women and midwives with dictated midwifery care, with the wellbeing of the fetus being of primary concern.

[...] By using the above search terms whilst searching in individual journals such as the British Journal of Midwifery and Midwifery many articles were found, both research and non-research. The University also provides databases on its website. Ebscohost, Science Direct and Blackwell Synergy provide access to a vast range of articles. The Cochrane Library (again available on the University library website) provides access to reviews of existing research, collated into concise papers. Internurse is another database that allows entry into a wide selection of midwifery journals. [...]

[...] The North Staffordshire Changing Childbirth Research Team in their 2000 study, aimed to evaluate caseload midwifery in comparison with traditional shared-care. Their outcome measures looked at known carer present at delivery, normal vaginal delivery and obstetric intervention rates. Their design was a comparative study with area randomisation. The design is non- experimental as it does not attempt to exert control. They have used a comparative design comparing results between one cohort and another to see if differences exist between the outcomes. [...]

[...] As midwifery can be seen to be an amalgam of both social and natural science (Hekman cited in Donovan p166), it may be appropriate to use more than one approach to research (Donovan, 2000). Triangulation is a term that refers to combining more than one approach to research, for example qualitative and quantitative, in order to consider a subject from different viewpoints (Donovan, 2000). For example, Walsh's qualitative study could be combined with Page et al's 2001 quantitative study on how one-to-one midwifery care affects medical intervention rates. [...]