Unpicking The Evidence: An Introduction to Research
PLEASE READ: The information provided by the Positively Birthing Blog and in my capacity as a hypnobirthing teacher is not intended to be medical advice. If you have concerns or questions relating to your personal situation, please contact your midwife or a suitable health professional who has access to your medical notes.
Throughout your pregnancy journey, you will likely encounter many healthcare professionals, who help keep you and you baby safe and healthy. But somewhere along the line, you may find yourself in a situation where you are offered a pathway of care, intervention or procedure that you don’t feel sure about. Why are you being offered it? What does it involve? What are the potential benefits and risks of accepting? What are the potential benefits and risks of NOT accepting? One of the most important things to remember about you care is that YOU are in charge of your body, your baby, your pregnancy and your birth, and though health professionals are able to advise you and offer information, the final decision will always lie with you. One of the key tools learned in hypnobirthing is around decision making and learning how to use your BRAIN (More on that later).
Sounds like a big responsibility huh? How can you be expected to make such huge decisions, without knowing all the facts? Your midwives, doctors, nurses and health visitors are obliged to provide you with up to date, evidence based information- and for the sake of argument, we’ll assume in this case that they are doing just that. But what does that mean?
Everyone that works in the NHS follow something called the ‘NICE Guidelines’, which are put together by the government and updated each year as new research is undertaken. They also follow their own Hospital Protocols, which, though also evidence based, take into account things like hospital budget, available staff and tools, and trends and preferences of the local population. For instance, the current NICE Guidelines for an active third stage of labour (delivery of the placenta with help from an injection, more on that later!) recommend use of a drug called ‘syntocinon’, however many hospitals still routinely use another drug called ‘syntometrine’ (equally effective, but with more side effects such as nausea and vomiting) because it is cheaper. It’s unlikely you will be offered a choice in an instance such as this, but that doesn’t mean you can’t make a request if you have a preference. (I did!). And there are many little variations like this from hospital to hospital.
OK, so the healthcare professionals are giving me evidence based information, so I should just do what they say right? Now this is where things get complicated, so bear with me! Just one heavy paragraph, I promise! All guidelines are based on evidence- but evidence is ranked on a scale from 1-4 depending on the quality of the research, this varies from a ‘Randomised Control Trial’ (the most reliable form of research, but often difficult to undertake on pregnant women) to ‘expert opinion’. We also need to understand the difference between something called ‘population risk’ and ‘individual risk’- essentially, most guidelines are also written to be applicable to a pregnant population as a whole and reduce adverse outcomes on a national scale, but you are a unique individual, with an endless number of variables, so we need to work out how does this research apply to YOU in THIS pregnancy. In our ‘Unpicking the Evidence’ project, we aim to do just that!
Now, there’s no way you can expect to wade your way through every pregnancy based research paper and guideline in nine months of pregnancy, let alone the few days or hours you have when making some decisions, so the key is prioritising, questioning and being involved in decision making. If there is a particular situation you feel worried about getting in to, do some reading in advance. If you are faced with a decision, do not be afraid to take some time away to do your own reading or bring research to discuss directly with your healthcare provider. The NICE Guidelines are available for anyone to access, and will reference the research papers on which they are based, and hospital policies can be accessed by getting in touch with your local hospital. (Ps. Mumsnet articles on how someone’s pet dog gave birth to triplets in a bush don’t count as 'research'!). Obviously, we cannot expect every midwife and every doctor to have knowledge of every research paper off the top of their head, and that is fine, they’re only human! But a good health care provider will be happy to admit when they don’t have an answer, talk you through any procedure or plan, seek advice from a senior colleague and read further around your individual situation as required. And if you’re not happy, ask to see someone else!
Now, before we begin, it’s worth reinforcing that in some situations, medical interventions are necessary, beneficial and even life saving! In our ‘Unpicking the Evidence’ project, we will take a snapshot look at some of the evidence around procedures that you may be offered in your pregnancy and birth. I would urge you to discuss everything with your own midwife or obstetrician before making any decisions, as they will have an understanding of your individual situation and medical background. If you are not happy with the care you are receiving, you can request to see another health professional at any point (including in labour).
For information on birth choices and help understanding how evidence applies to your own situation, contact AIMS.
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