What do we mean by evidence?
Mary NewburnHead of Research and Information,
NCT
NCT 2010-2020 Strategy themes Confident parents
Supportive services
Positive image of parenthood
High-quality information
An efficient organisation.
High-quality information
NCT aims include:
ā¢ To create and provide more parent-centred information about the transition to parenthood
ā¢ To ensure our public health information is evidence-based, non-judgemental and user-friendly
Confident parents
NCT aims include:
ā¢ To publicly champion the benefits of well-supported and informed parents.
ā¢ To improve our social and geographical reachā¦ā¢ To tailor our multi-channel support, including web-based and
telephone services, to ensure that parents get the information they need, when they need it.
ā¢ To enhance our baby feeding information and services providing information focused on parentsā needsā¦
This talk includes
ā¢ A look at the history of maternity care and the use (or otherwise) of evidence.
ā¢ What is āevidence-based medicineā or evidence-based healthcare, or education?
ā¢ Midwifery and social science research ā¢ Feedback form the ātrain and meetā sessionsā¢ Opportunities to find out more about evidence.
History
ā¢ Antenatal care is less than 100 years old. J W Ballantyne: āfounding father of antenatal careā interested in āthe prevention of monstrositiesā
ā¢ 18th C spearmint and opium were prescribed for vomiting. Laxatives and keeping the feet warm also popular remedies. Meat was considered dangerous. Cheerful disposition important for optimal fetal development.
ā¢ 19th C external palpation of the uterus during pregnancy first reported in The Lancet (1858). āBleedingā - āit is by no means rare for women to be bled six or eight times during the latter monthsā (Playfair 1898).
ā¢ 19th C One vaginal exam for the wealthy in the 7th month ā opiates āand her labia rubbed with opium tincture and softened with linseed or starch fomentationsā.
Ann Oakley (1982) āThe Origins and development of antenatal careā in Enkin M and Chalmers I (eds.) Effectiveness and satisfaction in antenatal care. Spastics International Medical Publications
History
ā¢ Concern about the ill-health of the infantry. Only two-fifths capable 1902 Major General Maurice, āa matter of imperial importanceā.
ā¢ First British antenatal outpatients clinic opened in 1915 by Dr Ferguson in Edinburgh. The fetal heart was first heard in 1918 (through a corset, while listening for splashing!).
ā¢ First antenatal clinic in Australia 1910 and the US in 1911.
Ann Oakley (1982) āThe Origins and development of antenatal careā in Enkin M and Chalmers I (eds.) Effectiveness and satisfaction in antenatal care. Spastics International Medical Publications
History
ā¢ The Boston Lying-in Hospital offered extensive home visiting during pregnancy, every 10 days, initiated by the Instructive Nursing Association in 1901.
ā¢ Sylvia Pankhurst lobbied for services that did not involve āthe inevitable long waitā, āamidst a crowdā (1930).
ā¢ āIn the development of the maternity services there is a special need for a close study of the womanās point of viewā (Royal Commission on Population, 1949)
ā¢ In 1915 an āincalculably smallā number of women received antenatal care but by 1935 this had risen to 80% of women (place not stated. Implies UK or England and Wales). But this care, lobbied for by the womenās movement after securing the right to vote, was based largely on assumptions. ā(It was ) taken for granted that more medical care would reduce mortalityā.
Ann Oakley (1982) āThe Origins and development of antenatal careā in Enkin M and Chalmers I (eds.) Effectiveness and satisfaction in antenatal care. Spastics International Medical Publications
Historical evidence on antenatal care
ā¢ Positive step forward: The first āembryonic confidential enquiryā on Maternal Mortality was published in 1924 by Dr Janet Campbell.
ā¢ Assumption: Only 21% of women who dies had received any antenatal care and it was asserted that this would improve outcomes (i.e. reduce maternal mortality).
ā¢ Progress? Later reports (1927, 1930, 1932) repeated the assertion about the importance of antenatal care, and the need to expand the antenatal work of maternity centres.
ā¢ Evidence: āin 1933 the maternal mortality rate was seven per cent higher than in the previous year and 15 per cent higher than 20 years previouslyā (Holland 1935). Use of induction of labour and caesarean section had increased and often led to poorer outcomes for women. āAntenatal supervision in many cases simply transfers mortality from one column to anotherā (Browne, 1932).
Ann Oakley (1982) āThe Origins and development of antenatal careā in Enkin M and Chalmers I (eds.) Effectiveness and satisfaction in antenatal care. Spastics International Medical Publications
Historical evidence on antenatal care
ā¢ The Midwives Act 1902 āto secure the better training of midwives and to regulate their practiceā.
ā¢ From 1948 the services of a midwife and a doctor were available; without charge.
ā¢ Hospital birth rate 35% in 1937, 65% in 1957, about 95% today.
Evidence based medicine
The last 20 years has seem the development of the āevidence-based medicineā or āevidence-based healthcareā movement.
āEvidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patientsā
Evidence based medicine: what it is and what it isn'tDavid L Sackett, William M C Rosenberg, J A Muir Gray, R Brian Haynes, W Scott RichardsonBMJ 1996. http://www.bmj.com/content/312/7023/71.full
Good medical practice
āGood doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough.
Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient.
Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.ā
Evidence based medicine: what it is and what it isn'tDavid L Sackett, William M C Rosenberg, J A Muir Gray, R Brian Haynes, W Scott RichardsonBMJ 1996. http://www.bmj.com/content/312/7023/71.full
Individual clinical expertise involvesā¦.
āā¦thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care.ā
Evidence based medicine: what it is and what it isn'tDavid L Sackett, William M C Rosenberg, J A Muir Gray, R Brian Haynes, W Scott RichardsonBMJ 1996. http://www.bmj.com/content/312/7023/71.full
Prof Archie Cochrane
ā¢ The evidence-based medicine movement started as a radical, critical movement which challenged established medicine.
ā¢ "I knew that there was no real evidence that anything we had to offer had any effect on tuberculosis, and I was afraid that I shortened the lives of some of my friends by unnecessary intervention."
Prof Archie Cochrane
ā¢ His advocacy of randomized controlled trials eventually led to the development of the Cochrane Library database of systematic reviews, the establishment of the UK Cochrane Centre in Oxford and the international Cochrane Collaboration.
Sir Iain Chalmers
ā¢ Effective care in Pregnancy and Childbirth (Chalmers, Enkin and Keirse, 1989) and the Guide to Effective care in Pregnancy and Childbirth
ā¢ Founder of the Cochrane Collaboration, now with 30,000 volunteers contributing .
ā¢ James Lind Alliance, āaims to identify the most important gaps in knowledge about the effects of treatmentsā.
Sir Iain Chalmers
Sir Iain Chalmers Why are systematic reviews of research on the effects of policies and practices so important? Tuesday 28 September 2010, Old Sessions House, North Holmes Campus, Canterbury
āDecisions to use or withhold interventions in health care, social care and education should take account of findings in systematic reviews of relevant and reliable research evidence. Continued failure to do this will result in continued avoidable suffering and death, and waste of resources.ā
Prof Mary Renfrewā¢ There are also midwife researchers who have
made a major contribution to knowledge about the transition to parenthood and topics of prime importance to NCT. Professor Mary Renfrew is one example.
ā¢ Breast feeding and child behaviour in the Millennium Cohort Study (2011)
ā¢ Men and Infant Feeding: Perceptions of Embarrassment, Sexuality, and Social Conduct in White Low-Income British Men (2011)
ā¢ Factors influencing the infant feeding decision of socioeconomically deprived pregnant teenagers: The Moral Dimension (2010)
ā¢ Breastfeeding promotion for infants in neonatal units: a systematic review (2010)
Prof Jane Sandall
ā¢ Professor Jane Sandall is another.
ā¢ Individual or group antenatal education for childbirth or parenthood, or both, In: Issue 3, The Cochrane Library (2007)
ā¢ Understanding the social organisation of maternity care systems: Midwifery as a touchstone, Sociology of Health and Illness, 27,6:722-737.
Professor Jo Green
ā¢ Professor Jo Green is a social scientist whose contribution to knowledge on maternity care and the effects of behaviour has been considerable.
ā¢ Screening for postnatal depression - is it acceptable to women and healthcare professionals? A systematic review and meta-synthesis. Journal of Reproductive and Infant Psychology 2010; 28(4): 328-3
ā¢ Converting policy into care: women's satisfaction with the early labour telephone component of the All Wales Clinical Pathway for Normal Labour. J Adv Nurs 201144
ātrain and meetā sessions
An opportunity for
consultation - about NCT workersā views about, and commitment towards, the aim of being both parent-centred and evidence-based.
Thank you ā It is good to know that there is an overwhelming commitment to this approach.
ātrain and meetā sessions
An opportunity for
evidence-gathering regardingā¢ NCT workersā competence and
confidence in using evidence in different circumstancesā¢ Perceptions of individualās
strengths and barriersā¢ Opportunities and the obstacles
in the organisationā¢ Training and support needs of
NCT workers
Thank you and watch this space. ā¦ To find out about journal club contact [email protected]
ātrain and meetā sessions
An opportunity for
training ā ā¢ sharing experiences and
good practice among the delegates
ā¢ introduction to different types of scientific evidence and what is meant by āeffectivenessā.
What does NCT mean by evidence-based?
NCT plans to ā¢ Set standards and develop guidance for the NCT
group regarding the quality and range of evidence, and key evidence sources, which should be used.
ā¢ For further information contact [email protected] or [email protected]