Download The environment

Developing guidelines for midwife-led care
The role of the Royal College of Midwives
in
leading practice
Frances Day-Stirk
Royal College of Midwives
Director Learning Research & Practice Development
International Office
Rio de Janeiro 4 November 2009
The voice of midwifery in the United Kingdom
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Professional organisation and trade union for midwives led
by midwives for midwives
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The vast majority of the midwifery profession are members.
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represents the interests of midwives in all four UK countries
individually and collectively.
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promote excellence, innovation and leadership in the
care of childbearing women, the newborn and their
families, nationally and internationally.
Strategic intentions
As part of the strategy to promote the
midwifery profession and support midwifery
practice, the Royal College of Midwives (RCM)
developed several of approaches
Aim: to improve midwifery practice and
encourage a national standard of practice, by
producing quality reference (d) documents for
local use
Key initiatives
RCM Evidence Based Midwifery peer-reviewed
research journal – launched 2003
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promotes the dissemination,
implementation and
evaluation of midwifery evidence
locally, nationally and internationally.
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publishes papers - qualitative or quantitative
research studies, philosophical analyses and
systematic reviews.
Midwife-led care has an underpinning philosophy of
labour as a normal physiological process. It also
recognises that, for the woman, labour is not ‘just
normal’ but actually extraordinary: as a ‘good’ or
‘bad’ experience it has great implications for her
psychological well-being and her relationships with
her family
Wiklund et al 2008; Lemola et al 2007; Waldenstrom et al 2004; Simkin 1992
‘Hands-on’ guidance for
midwives doing home
birth (2003)
Common concerns when
developing home birth
practice
Guidance on practical
information –
Antenatal preparation,
labour and postnatal care
in the home environment
Evidence-based midwifery led care in labour
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First two editionsdeveloped for use in one
NHS Trust, UK
(Helen Spiby & Jane
Munro)
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Third editioncommissioned by the
Royal College of Midwives
intrapartum care in
midwifery-led
environments,
midwifery-led
schemes
Guiding principles
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Process for developing and evaluating guidelines should
focus on outcomes valued by users
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The guidelines should be based on best available
evidence and include a statement about the strength of
evidence
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A sound method of critical analysis should be adopted
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The guidelines should be flexible and adaptable
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There is evidence of user involvement and other
appropriate professionals
The Process
Suitability screen
o Scope
o Literature search
o Grading of recommendations
o Audit
o Peer Review
o Declaration of interests
o Support
o Disclaimer
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Context and philosophy
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Evidence base to midwifery care
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Clinical practice guidelines
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Midwifery-led approaches to care
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Information and involvement in decision-making
Identifying topics for inclusion
o Preparatory survey
usefulness & acceptability to midwives
o Identification of topics via stakeholders
Midwives - Evidence Based Midwifery
Network & Royal College of Midwives
Women - via User Groups at national
level
Literature review
o prospective randomised controlled trials
o midwives’ research and reviews exploring
women’s views
o professional bodies (RCM & RCOG) and
government policy directives
o expert opinion
Search strategy
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Search of electronic
databases
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Cochrane, Medline, CINAHL,
MIDIRS
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English language papers or
abstracts
Publication period
Separate search strategy
each topic
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Guideline databases and
collections
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MeSH headings and keyword
terms
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Hand searching of six key
journals
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Formulation of recommendations
o Critical appraisal
o Research conducted in settings & contexts
relevant to midwifery-led care
o Two authors peer reviewed each section
o Presented as a narrative and in bullet points
o No grading of evidence
Evaluation
o Peer review
o Use of the AGREE tool
o Midwifery guideline experts
o Service users/representatives
Guideline titles
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Birth Environment
Latent Phase
Supporting Women in Labour
Supporting and Involving Women’s Birth Companions
The Use of Water for Labour and Birth
Pharmacological Pain Relief
Fetal Heart Rate Monitoring
Assessing Progress in Labour
Rupturing Membranes
Positions for Labour and Birth
Persistent lateral and posterior fetal positions at the onset of
labour
Second Stage of Labour
Care of the Perineum
Third Stage of Labour
Suturing the Perineum
Immediate Care of the Newborn
Early Breastfeeding
Birth Environment Practice Points
Go to website
http://www.rcm.org.uk/college/standards-and-practice/practice-guidelines/
Evidence based midwife-led care &
clinical governance
Working in
‘in an environment that is open and participative,
where ideas and good practice is shared, where
education and research is valued’
Scally & Donaldson 1998
Can mean learning how to ‘start stopping’
The environment
Hospital is an alienating environment for most women, in which
institutionalised routines and lack of privacy can contribute to
feelings of loss of control and disempowerment
Lock and Gibb 2004; Steele 1995
Control, or lack of it, has been found to be important to women’s
experience of labour and their subsequent emotional wellbeing
Green et al 1990; Simkin 1992
The home-like environment is associated with lower rates of
analgesia, augmentation and operative delivery, as well as
greater satisfaction with care
Hodnett et al 2005
Fetal heart rate monitoring
Because of the high level of intervention
associated with electronic fetal monitoring,
intermittent auscultation with a hand held
instrument is the recommended method for the
woman who is healthy and has had an
uncomplicated pregnancy
NICE 2007; MIDIRS 2005; RCOG 1993
Current evidence does not support the use of the
admission CTG in low risk pregnancy. It should
not be used routinely
NICE 2007; MIDIRS 2005; Blix et al 2004; Impey et al 2003; Mires et al
2001
Midwife-led care has been found to have as good
outcomes as medical-led and shared care, met
with greater satisfaction from the women and
reduced obstetrical intervention rates
Hatel et al 2009; Campbell et al 1999; McVicar et al 1993; Shields et al 1998;
Turnbull et al 1996; Hundley et al 1994; McVicar et al 1993
Obrigado
www.rcm.org.uk
http://www.rcm.org.uk/ebm/
http://www.rcm.org.uk/college/standards-andpractice/practice-guidelines/
Acknowledgements
Jane Munro & Mervi Jokinen