Research Methods and Methodologies for Midwifery Practice
The aim of this research assignment is to demonstrate the ability to critically appraise two pieces of research evidence which relates to midwifery and use the evidence to make recommendations for change to improve the quality of care.
The topic that has been chosen is what is the best management to prevent perineal trauma during labour and the long term effects perineal trauma has on women. In particular the “Hands Off or Hands On” (HOOP) technique will be researched. The reason for this chosen topic is the management of the perineum during the second stage of labour is varied and often at the preference of the midwife in attendance. Therefore student midwives are being taught
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The Table of hits in appendix one shows the overall results from the search strategy. Quotation marks were used around each phrase so only research with that phrase would be returned and Boolean operators were used to link together the subjects (Gosall and Gosall, 2012). Advanced searches were then carried out to relate the searches to midwifery and only research from 2010 onwards was used so most up to date. The problems that arose were some of the topics were not related to midwifery i.e. Hoola hooping and also some research had to be paid for so this research was not used. Medical databases were used to search the available literature. The following two articles were chosen to critically appraise in detail:
Women’s experiences following severe perineal trauma: a qualitative study (Priddis, Schmied and Dahlen, 2014) and;
Hands on or hands off the perineum: a survey of care of the perineum in labour (HOOPS) (Trochez, Waterfield and Freeman, 2011).
Women’s experiences following severe perineal trauma: a qualitative study will be critically appraised first. To critically appraise this research the CASP tool for qualitative research was used which is a tool help individuals understand the research evidence in order to apply evidence to practice. The CASP tool enables the reader to assess the
The National Institute for Health and Clinical Excellence (NICE, 2007) Intrapartum guidelines state that during the first stage of labour women should be encouraged to adopt the position they feel most comfortable in. This is what the student was trying to encourage even though her mentor did not.There are various positions the woman can adopt in labour which are generally grouped into upright and recumbent. The positions classed as upright are; standing, walking, kneeling, squatting, on all fours and sitting, and the recumbent position could include; supine, lithotomy, semi-recumbent or side lying (Johnson and Taylor, 2011). The upright position appeared to be more beneficial in Sarah’s case and the author wants to determine if this is always the case. It is evident that sometimes there will be constraints such as continuous fetal monitoring but it is important that the midwife does
Providing an effective care and support to the patient and for their babies during labour
Randomization was used to generate what patient went to which group. The way the patients were chosen eliminated bias because “Randomization was performed according to a computer-generated list by means of sequentially numbered, opaque, sealed envelopes which revealed the allocation of the subject to either induction or expectant management”(Nielsen et al. p. 60). This secure randomization added a great strength to the study. The sample size seemed fairly large, 226 patients were split into 116 for elective induction and 110 to expectant management, although the power analysis was disclosed in this study and determined that 600 patients were required. Only 226 patients were used and because it would take 4 years to reach the required amount of patients, the study was discontinued. This was both a strength and weakness because disclosing this information made the study more honest but the quota needed to reach the best answers was not attained. The study for the 226 patients was pretty standard with the 80% power and alpha at 0.05. T-test and chi square tests were used to compare the proportions between the groups of people. The women were chosen based on the inclusion criteria of being 39 weeks gestation or older, maternal age of more than 17, fetal cephalic presentation, singleton gestation, a candidate for vaginal delivery, and a Bishop score of 5 or greater in nulliparous women and 4 or greater for multiparous women. This inclusion criterion was a concern because both nulliparous women and multiparous women were being tested together. This was a weakness because the labor patterns of a nulliparous woman compared to a multiparous woman are very variable and sure to distort study data. It was also disclosed how gestational age was achieved which included the crown rump test measured in 6-12
The Nursing and Midwifery Council (2008) state in their code of conduct state that nursing and midwifery care must be evidence or best practise based. Therefore it is essential that students are able to analyse and critique research papers in order to determine the validity of the study and to apply theories to practise.
Obstetricians and midwives both have a standard that they all need to be aware of and know when working with women in antenatal, birth and post natal. They need to both be able to help assist the women in choosing a mode of care that is suitable for her needs. (Ranzcog.edu.au, 2011)
The assignment will be written in the style of the British Journal of Midwifery (BJM), the abstract is incorporated into this introduction and Harvard 2014 will be used for the referencing style.
Critique of Borders et al.’s Study (2013) “Midwives’ Verbal Support of Nulliparous Women in Second-Stage Labor”
There are very few non pharmacological options when it comes to pain control for laboring women. This implementation plan will discuss the benefits of implementing the water birth as a mode of pain control. It will include details of the water labor protocol that is to be proposed, resources needed for the implementation, time frame, cost, instruments used, data collection methods, facilitators, and barriers to the protocol.
The phenomenon of interest (birth trauma and what it means to women) was clearly identified in the report. In the introduction the authors stated that women’s perception of birth trauma is quite different from the perception of the same phenomenon by health care providers. She also uses a term “in the eyes of the beholder” to emphasize that for every woman this phenomenon is unique. It is stated that PTSD after childbirth is quite prevalent and several studies support this fact. However, research is regarding the understanding of the birth trauma phenomenon from the woman’s experience lacking. The problem statement was worded clearly and directly and I wasn’t ambivalent about what problem will be discussed in the remainder of the article.
The ANMC states that midwives should promote safe and effective practice. This competency standard involves: Applying knowledge, skills and attitudes to enable woman centred care, provide or support midwifery continuity of care and manage the midwifery care of women and their babies. Midwives providing continuity of care are able to provide safe and effective practice. They know there patients well from the woman’s blood test results to the woman’s birth plan. The midwife can provide safe and effective practice because she knows the woman best. Midwifery Continuity of care is associated with a reduction in the rate of a number of interventions, without compromising safety of care (Spiby &
This essay will first describe partnership and how a midwife working in the continuity of care model develops and maintains it. Secondly, this essay will describe what a postnatal abdominal palpation is, why it is done and what the outcomes may be. It will also describe the anatomy and physiology of a uterus and involution. Lastly, a description of how the assessment is conducted and how during this partnership and cultural safety is maintained by the midwife.
As the recommendation has been established as best practice this chapter will propose a clinical audit to review the extent to which the recommendation is applied in practice. Practitioners have a responsibility to continually improve their standards of care (Nursing and Midwifery Council, 2010). Clinical audits are a valuable tool for professionals to monitor their current practice and promote improvements in care (Benjamin, 2008).
Providing continuous physical and emotional support during labour can reducing maternal fear, stress, and anxiety and protect physiological birth (Steen, 2012). Research shows that fear and anxiety during labour and birth can be detrimental to physiological birth. An environment that women feel unsafe in may stimulate a surge of neuro-hormones that can influence both fetal and maternal physiology, causing irregularity of contractions, fetal distress and subsequent medical inteverntions (Fahy & Parratt, 2006). Conversly, maintaining an environment where women feel safe, protected and supported can facilitate favourable physiological performance (Fahy & Parratt, 2006). Midwives can do this by giving women one-on-one continuous support and placing her at the centre of care throughout childbirth (Steen, 2012). As observed in practice, by constantly reassuring the woman about her progress, her baby’s health and addressing any of her concerns, the midwife can provide a calm and relaxing environment that is conducive to the labouring woman (Buckley, 2015; Steen, 2012). The midwife worked with the woman, encouraging her throughout labour and birth by telling her that she was doing extremely well. The midwife also breathed in-tune with the woman while giving her a back massage, inducing a sense of comfort. The atmosphere was calm and this contributed to the woman garnering confidence in her ability to avoid medical pain relief. Downe (2008) noted that the positive impact of
Central Idea: Pain management is an important aspect of childbirth that women need to educate themselves on so they can make an informed decision when choosing which method they will use.
Over the years birthing methods have changed a great deal. When technology wasn’t so advanced there was only one method of giving birth, vaginally non-medicated. However, in today’s society there are now more than one method of giving birth. In fact, there are three methods: Non-medicated vaginal delivery, medicated vaginal delivery and cesarean delivery, also known as c-section. In the cesarean delivery there is not much to prepare for before the operation, except maybe the procedure of the operation. A few things that will be discussed are: the process of cesarean delivery, reasons for this birthing method and a few reasons for why this birthing method is used. Also a question that many women have is whether or not they can vaginally