Dear Denis,
A recent article reprinted in Midirs discusses the lack of evidence concerning routine vaginal examinations, including reference to a recent Cochrane review. Reference is;-
Dahlen et al. (2014) Vaginal examinations during normal labour: routine examination or routine intervention? MIDIRS Midwifery Digest, 24(1), pp. 67 – 76.
Kind regards,
Val
Dr. Valerie Larkin
Faculty of Health and Life Sciences
Northumbria University
0191 2156134
[log in to unmask]
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of MIDWIFERY-RESEARCH automatic digest system
Sent: 01 April 2014 00:01
To: [log in to unmask]
Subject: MIDWIFERY-RESEARCH Digest - 30 Mar 2014 to 31 Mar 2014 (#2014-82)
There are 9 messages totaling 4853 lines in this issue.
Topics of the day:
1. FW: [REPRONETWORK] CFP for AAA on midwifery
2. Listening to Parents - The impact of stillbirth and neonatal death
3. are intrapartum guidelines evidence based (5)
4. water injections for back pain (2)
----------------------------------------------------------------------
Date: Mon, 31 Mar 2014 06:51:57 +0000
From: "Sandall, Jane" <[log in to unmask]>
Subject: FW: [REPRONETWORK] CFP for AAA on midwifery
[Message contains invalid MIME fields or encoding and could not be processed]
------------------------------
Date: Mon, 31 Mar 2014 09:08:43 +0000
From: Jane Henderson <[log in to unmask]>
Subject: Listening to Parents - The impact of stillbirth and neonatal death
Dear all,
The programme for this meeting can be found at the following link: http://www.rsm.ac.uk/academ/mbe02.php <http://www.rsm.ac.uk/academ/mbe02.php> .
It will be at the RSM in London on 9th April.
Best wishes,
Jane Henderson
Researcher
National Perinatal Epidemiology Unit
Nuffield Department of Population Health University of Oxford Old Road Campus Oxford OX3 7LF
Tel 01865 289758
Fax 01865 289701
[AS_RGB_Silver-Award_sml]
------------------------------
Date: Mon, 31 Mar 2014 16:23:09 +0100
From: Denis Walsh <[log in to unmask]>
Subject: are intrapartum guidelines evidence based
Does anyone know of papers that have estimated how much of routine intrapartum practice is evidence-based? The query stems from anaesthetists not accepting the introduction of water injections for back pain in an alongside midwifery unit unless a Cochrane review unequivocally shows benefit and recommends it (setting aside the issue of one professional group having the right of veto over another groups sphere of practice). We are looking for papers that summarise a cluster of therapies/interventions that are common practice with less of an evidence base than a robust Cochrane review and that the judgement about what therapies/interventions pass the test of robust evidence may be influenced by prior beliefs/preferences. There may also be literature that the decision of what is 'approved' for practice is related to the most powerful voices locally.
Many thanks.
Best wishes,
Denis
Dr Denis Walsh
Associate Professor in Midwifery
Postgraduate Director of Research & Knowledge Transfer Academic Division of Midwifery University of Nottingham A Floor Medical School Queens Medical Centre Derby Rd Nottingham NG7 2UH
Tel: +44(0)115 8230987
Mobile: 07905735777
Email: [log in to unmask]<mailto:[log in to unmask]>
This message and any attachment are intended solely for the addressee and may contain confidential information. If you have received this message in error, please send it back to me, and immediately delete it. Please do not use, copy or disclose the information contained in this message or in any attachment. Any views or opinions expressed by the author of this email do not necessarily reflect the views of the University of Nottingham.
This message has been checked for viruses but the contents of an attachment
may still contain software viruses which could damage your computer system, you are advised to perform your own checks. Email communications with the University of Nottingham may be monitored as permitted by UK legislation.
------------------------------
Date: Mon, 31 Mar 2014 15:57:00 +0000
From: Thomas McEwan <[log in to unmask]>
Subject: Re: are intrapartum guidelines evidence based
Hi Denis,
I haven't found any specific articles related to this but wondered if the NICE guidance on Intrapartum Care might provide a useful starting point for further evidence gathering.
I have personally experienced this type of 'veto' in the past despite the case that the evidence provided is often of poor quality.
http://www.nice.org.uk/nicemedia/pdf/IPCNICEGuidance.pdf
Best wishes and kind regards
Tom.
Tom McEwan
Lecturer in Midwifery (Maternal, Child & Family Health)
T: +44 (0)141 849 4272<tel:+44%20(0)141%20849%204272>
E: [log in to unmask]<mailto:[log in to unmask]>
W: www.uws.ac.uk<http://www.uws.ac.uk/>
A: School of Health, Nursing and Midwifery, A420, University of the West of Scotland, High Street, Paisley, Renfrewshire PA1 2BE
On 31 Mar 2014, at 16:40, "Denis Walsh" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Does anyone know of papers that have estimated how much of routine intrapartum practice is evidence-based? The query stems from anaesthetists not accepting the introduction of water injections for back pain in an alongside midwifery unit unless a Cochrane review unequivocally shows benefit and recommends it (setting aside the issue of one professional group having the right of veto over another groups sphere of practice). We are looking for papers that summarise a cluster of therapies/interventions that are common practice with less of an evidence base than a robust Cochrane review and that the judgement about what therapies/interventions pass the test of robust evidence may be influenced by prior beliefs/preferences. There may also be literature that the decision of what is ‘approved’ for practice is related to the most powerful voices locally.
Many thanks.
Best wishes,
Denis
Dr Denis Walsh
Associate Professor in Midwifery
Postgraduate Director of Research & Knowledge Transfer Academic Division of Midwifery University of Nottingham A Floor Medical School Queens Medical Centre Derby Rd Nottingham NG7 2UH
Tel: +44(0)115 8230987
Mobile: 07905735777
Email: [log in to unmask]<mailto:[log in to unmask]>
This message and any attachment are intended solely for the addressee and may contain confidential information. If you have received this message in error, please send it back to me, and immediately delete it. Please do not use, copy or disclose the information contained in this message or in any attachment. Any views or opinions expressed by the author of this email do not necessarily reflect the views of the University of Nottingham.
This message has been checked for viruses but the contents of an attachment may still contain software viruses which could damage your computer system, you are advised to perform your own checks. Email communications with the University of Nottingham may be monitored as permitted by UK legislation.
Please consider the environment and think before you print
***************************************************************************************************************
University of the West of Scotland aims to have a transformational influence on the economic, social and cultural development of the West of Scotland and beyond by providing relevant, high quality, inclusive higher education and innovative and useful research.
Visit www.uws.ac.uk for more details
University of the West of Scotland is a registered Scottish charity. Charity number SC002520.
***************************************************************************************************************
Legal disclaimer
--------------------------
The information transmitted is the property of the University of the West of Scotland and is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Statements and opinions expressed in this e-mail may not represent those of the company. Any review, retransmission, dissemination and other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited.
If you received this in error, please contact the sender immediately and delete the material from any computer.
--------------------------
------------------------------
Date: Mon, 31 Mar 2014 16:00:19 +0000
From: "Jonge, Ank de" <[log in to unmask]>
Subject: Re: are intrapartum guidelines evidence based
Dear Denis,
To mention two Dutch studies that showed no evidence for two commonly used interventions: the use of internal monitoring of the strength of contractions and induction for suspected growth restriction at term (see references below). Interestingly, in Boers' study they found no difference between induction and expectant management. Hence, you would expect the conclusion to be in favour of expectant management ('primum non nocere' or 'first do no harm') but the conclusion in the abstract reads: Patients who are keen on non-intervention can safely choose expectant management with intensive maternal and fetal monitoring; however, it is rational to choose induction to prevent possible neonatal morbidity and stillbirth.
Considering the potential side effects of induction compared to sterile water injections (let alone the difference in effects) it is difficult to understand the strong belief in induction and the highly emotional rejection of sterile water injections. Beliefs are much stronger than evidence....
Before we start 'blaming' medics for these attitudes, midwives have them too. As you know very well and have published about - many more women end up lying on their back for labour than would naturally choose to do so (also with midwives attending the birth) ... In spite of tonnes of evidence of advantages of giving them more choices in positions.
Best wishes, Ank.
(1) Bakker JJ, Verhoeven CJ, Janssen PF, van Lith JM, van Oudgaarden ED, Bloemenkamp KW et al. Outcomes after internal versus external tocodynamometry for monitoring labor. N Engl J Med 2010; 362(4):306-313.
(2) Boers KE, Vijgen SM, Bijlenga D, van der Post JA, Bekedam DJ, Kwee A et al. Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT). BMJ 2010; 341:c7087.
Van: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] Namens Denis Walsh
Verzonden: maandag 31 maart 2014 17:23
Aan: [log in to unmask]
Onderwerp: are intrapartum guidelines evidence based
Does anyone know of papers that have estimated how much of routine intrapartum practice is evidence-based? The query stems from anaesthetists not accepting the introduction of water injections for back pain in an alongside midwifery unit unless a Cochrane review unequivocally shows benefit and recommends it (setting aside the issue of one professional group having the right of veto over another groups sphere of practice). We are looking for papers that summarise a cluster of therapies/interventions that are common practice with less of an evidence base than a robust Cochrane review and that the judgement about what therapies/interventions pass the test of robust evidence may be influenced by prior beliefs/preferences. There may also be literature that the decision of what is 'approved' for practice is related to the most powerful voices locally.
Many thanks.
Best wishes,
Denis
Dr Denis Walsh
Associate Professor in Midwifery
Postgraduate Director of Research & Knowledge Transfer Academic Division of Midwifery University of Nottingham A Floor Medical School Queens Medical Centre Derby Rd Nottingham NG7 2UH
Tel: +44(0)115 8230987
Mobile: 07905735777
Email: [log in to unmask]<mailto:[log in to unmask]>
This message and any attachment are intended solely for the addressee and may contain confidential information. If you have received this message in error, please send it back to me, and immediately delete it. Please do not use, copy or disclose the information contained in this message or in any attachment. Any views or opinions expressed by the author of this email do not necessarily reflect the views of the University of Nottingham.
This message has been checked for viruses but the contents of an attachment may still contain software viruses which could damage your computer system, you are advised to perform your own checks. Email communications with the University of Nottingham may be monitored as permitted by UK legislation.
------------------------------
Date: Mon, 31 Mar 2014 19:12:12 +0200
From: Nancy Stone <[log in to unmask]>
Subject: Re: are intrapartum guidelines evidence based
Dear Denis,
I can mention a few studies. This first study is challenging evidence-based practice in delivery of care, but in nursing in general.
Malone J, Seers K, Titchen A. et.al. (2004). What counts as evidence in evidence-based medicine? Journal of Advanced Nursing. 47(1):81-90.
The second one is a commentary from two OB/Gyn's in the USA on patient choice.
Leeman L, Plante L. (2006). Patient-Choice Vaginal Delivery? Ann Fam Med.
4:265-268.
The third article, in proposing a physiologic partograph, discusses the overdiagnosis of dystocia resulting in an overuse of interventions. I suppose by way of the back door, the article is saying that the interventions that are implemented during labour are not evidence-based by virtue of the fact that the actual beginning of labour is misdiagnosed.
Neal J, Lowe, N. (2012). Physiologic partograph to improve birth safety and outcomes among low-risk nulliparous women with spontaneous labor onset.
Medical Hypotheses. 78:319-326.
Maybe there is something helpful there.
Best,
Nancy Stone
On Mon, Mar 31, 2014 at 6:00 PM, Jonge, Ank de <[log in to unmask]> wrote:
> Dear Denis,
>
>
>
> To mention two Dutch studies that showed no evidence for two commonly
> used
> interventions: the use of internal monitoring of the strength of
> contractions and induction for suspected growth restriction at term
> (see references below). Interestingly, in Boers' study they found no
> difference between induction and expectant management. Hence, you
> would expect the conclusion to be in favour of expectant management
> ('primum non nocere' or 'first do no harm') but the conclusion in the
> abstract reads: Patients who are keen on non-intervention can safely
> choose expectant management with intensive maternal and fetal
> monitoring; however, it is rational to choose induction to prevent possible neonatal morbidity and stillbirth.
>
> Considering the potential side effects of induction compared to
> sterile water injections (let alone the difference in effects) it is
> difficult to understand the strong belief in induction and the highly
> emotional rejection of sterile water injections. Beliefs are much
> stronger than evidence....
>
>
>
> Before we start 'blaming' medics for these attitudes, midwives have
> them too. As you know very well and have published about - many more
> women end up lying on their back for labour than would naturally
> choose to do so (also with midwives attending the birth) ... In spite
> of tonnes of evidence of advantages of giving them more choices in positions.
>
>
>
> Best wishes, Ank.
>
>
>
>
>
> (1) Bakker JJ, Verhoeven CJ, Janssen PF, van Lith JM, van Oudgaarden
> ED, Bloemenkamp KW et al. Outcomes after internal versus external
> tocodynamometry for monitoring labor. *N Engl J Med* 2010; 362(4):306-313.
>
> (2) Boers KE, Vijgen SM, Bijlenga D, van der Post JA, Bekedam DJ,
> Kwee A et al. Induction versus expectant monitoring for intrauterine
> growth restriction at term: randomised equivalence trial (DIGITAT).
> *BMJ* 2010; 341:c7087.
>
>
>
>
>
> *Van:* A forum for discussion on midwifery and reproductive health
> research. [mailto:[log in to unmask]] *Namens *Denis
> Walsh
> *Verzonden:* maandag 31 maart 2014 17:23
> *Aan:* [log in to unmask]
> *Onderwerp:* are intrapartum guidelines evidence based
>
>
>
> Does anyone know of papers that have estimated how much of routine
> intrapartum practice is evidence-based? The query stems from
> anaesthetists not accepting the introduction of water injections for
> back pain in an alongside midwifery unit unless a Cochrane review
> unequivocally shows benefit and recommends it (setting aside the
> issue of one professional group having the right of veto over another
> groups sphere of practice). We are looking for papers that summarise a
> cluster of therapies/interventions that are common practice with less
> of an evidence base than a robust Cochrane review and that the
> judgement about what therapies/interventions pass the test of robust
> evidence may be influenced by prior beliefs/preferences. There may
> also be literature that the decision of what is 'approved' for practice is related to the most powerful voices locally.
>
> Many thanks.
>
> Best wishes,
>
> Denis
>
> Dr Denis Walsh
>
> Associate Professor in Midwifery
>
> Postgraduate Director of Research & Knowledge Transfer
>
> Academic Division of Midwifery
>
> University of Nottingham
>
> A Floor
>
> Medical School
>
> Queens Medical Centre
>
> Derby Rd
>
> Nottingham NG7 2UH
>
> Tel: +44(0)115 8230987
>
> Mobile: 07905735777
>
> Email: [log in to unmask]
>
>
>
>
>
> This message and any attachment are intended solely for the addressee
> and may contain confidential information. If you have received this message in
> error, please send it back to me, and immediately delete it. Please do
> not use, copy or disclose the information contained in this message or
> in any attachment. Any views or opinions expressed by the author of
> this email do not necessarily reflect the views of the University of Nottingham.
>
> This message has been checked for viruses but the contents of an
> attachment may still contain software viruses which could damage your
> computer system, you are advised to perform your own checks. Email
> communications with the University of Nottingham may be monitored as
> permitted by UK legislation.
>
>
>
------------------------------
Date: Mon, 31 Mar 2014 21:31:14 +0200
From: Sophie Alexander <[log in to unmask]>
Subject: Re: water injections for back pain
I did once see an underpowered RCT on the topic. Possibly an abstract at an EAPM meeting. I did not even know about this intervention. What I understood was that the issue was the primary outcome. Because if labour pains seem more acceptable because the water injection is SO painful, then what are we measuring?
De : A forum for discussion on midwifery and reproductive health research.
[mailto:[log in to unmask]] De la part de Denis Walsh Envoyé : lundi 31 mars 2014 17:23 À : [log in to unmask] Objet : are intrapartum guidelines evidence based
Does anyone know of papers that have estimated how much of routine intrapartum practice is evidence-based? The query stems from anaesthetists not accepting the introduction of water injections for back pain in an alongside midwifery unit unless a Cochrane review unequivocally shows benefit and recommends it (setting aside the issue of one professional group having the right of veto over another groups sphere of practice). We are looking for papers that summarise a cluster of therapies/interventions that are common practice with less of an evidence base than a robust Cochrane review and that the judgement about what therapies/interventions pass the test of robust evidence may be influenced by prior beliefs/preferences.
There may also be literature that the decision of what is approved for practice is related to the most powerful voices locally.
Many thanks.
Best wishes,
Denis
Dr Denis Walsh
Associate Professor in Midwifery
Postgraduate Director of Research & Knowledge Transfer
Academic Division of Midwifery
University of Nottingham
A Floor
Medical School
Queens Medical Centre
Derby Rd
Nottingham NG7 2UH
Tel: +44(0)115 8230987
Mobile: 07905735777
Email: [log in to unmask]
This message and any attachment are intended solely for the addressee and may contain confidential information. If you have received this message in
error, please send it back to me, and immediately delete it. Please do not
use, copy or disclose the information contained in this message or in any attachment. Any views or opinions expressed by the author of this email do not necessarily reflect the views of the University of Nottingham.
This message has been checked for viruses but the contents of an attachment may still contain software viruses which could damage your computer system, you are advised to perform your own checks. Email communications with the University of Nottingham may be monitored as permitted by UK legislation.
------------------------------
Date: Tue, 1 Apr 2014 08:24:31 +1100
From: Deborah Fox <[log in to unmask]>
Subject: Re: water injections for back pain
There has been a lot of work done on sterile water injections in Queensland, Australia, by Nigel Lee et al. - an RCT called the SWITCh trial, comparing one with four simultaneous injections. I know that is not the answer to your question, Denis, but may be of interest to some readers.
Cheers, Deb
On Tue, Apr 1, 2014 at 6:31 AM, Sophie Alexander <[log in to unmask]> wrote:
> I did once see an underpowered RCT on the topic. Possibly an abstract
> at an EAPM meeting. I did not even know about this intervention.
> What I understood was that the issue was the primary outcome. Because
> if labour pains seem more acceptable because the water injection is SO
> painful, then what are we measuring?
>
>
>
> De : A forum for discussion on midwifery and reproductive health research.
> [mailto:[log in to unmask]] De la part de Denis Walsh
> Envoyé : lundi 31 mars 2014 17:23 À :
> [log in to unmask] Objet : are intrapartum guidelines
> evidence based
>
>
>
> Does anyone know of papers that have estimated how much of routine
> intrapartum practice is evidence-based? The query stems from
> anaesthetists not accepting the introduction of water injections for
> back pain in an alongside midwifery unit unless a Cochrane review
> unequivocally shows benefit and recommends it (setting aside the
> issue of one professional group having the right of veto over another
> groups sphere of practice). We are looking for papers that summarise a
> cluster of therapies/interventions that are common practice with less
> of an evidence base than a robust Cochrane review and that the
> judgement about what therapies/interventions pass the test of robust evidence may be influenced by prior beliefs/preferences.
> There may also be literature that the decision of what is 'approved'
> for practice is related to the most powerful voices locally.
>
> Many thanks.
>
> Best wishes,
>
> Denis
>
> Dr Denis Walsh
>
> Associate Professor in Midwifery
>
> Postgraduate Director of Research & Knowledge Transfer
>
> Academic Division of Midwifery
>
> University of Nottingham
>
> A Floor
>
> Medical School
>
> Queens Medical Centre
>
> Derby Rd
>
> Nottingham NG7 2UH
>
> Tel: +44(0)115 8230987
>
> Mobile: 07905735777
>
> Email: [log in to unmask]
>
>
>
>
>
> This message and any attachment are intended solely for the addressee
> and may contain confidential information. If you have received this message in
> error, please send it back to me, and immediately delete it. Please do not
> use, copy or disclose the information contained in this message or in
> any attachment. Any views or opinions expressed by the author of this
> email do not necessarily reflect the views of the University of Nottingham.
>
> This message has been checked for viruses but the contents of an
> attachment may still contain software viruses which could damage your
> computer system, you are advised to perform your own checks. Email
> communications with the University of Nottingham may be monitored as permitted by UK legislation.
>
>
------------------------------
Date: Mon, 31 Mar 2014 22:25:39 +0000
From: Robyn Maude <[log in to unmask]>
Subject: Re: are intrapartum guidelines evidence based
The classic 'veto' is how the evidence around Admission CTG is used. I can't think of anything that meets your brief beyond the Enkin et al books
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Thomas McEwan
Sent: Tuesday, 1 April 2014 4:57 a.m.
To: [log in to unmask]
Subject: Re: are intrapartum guidelines evidence based
Hi Denis,
I haven't found any specific articles related to this but wondered if the NICE guidance on Intrapartum Care might provide a useful starting point for further evidence gathering.
I have personally experienced this type of 'veto' in the past despite the case that the evidence provided is often of poor quality.
http://www.nice.org.uk/nicemedia/pdf/IPCNICEGuidance.pdf
Best wishes and kind regards
Tom.
Tom McEwan
Lecturer in Midwifery (Maternal, Child & Family Health)
T: +44 (0)141 849 4272<tel:+44%20(0)141%20849%204272>
E: [log in to unmask]<mailto:[log in to unmask]>
W: www.uws.ac.uk<http://www.uws.ac.uk/>
A: School of Health, Nursing and Midwifery, A420, University of the West of Scotland, High Street, Paisley, Renfrewshire PA1 2BE
On 31 Mar 2014, at 16:40, "Denis Walsh" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Does anyone know of papers that have estimated how much of routine intrapartum practice is evidence-based? The query stems from anaesthetists not accepting the introduction of water injections for back pain in an alongside midwifery unit unless a Cochrane review unequivocally shows benefit and recommends it (setting aside the issue of one professional group having the right of veto over another groups sphere of practice). We are looking for papers that summarise a cluster of therapies/interventions that are common practice with less of an evidence base than a robust Cochrane review and that the judgement about what therapies/interventions pass the test of robust evidence may be influenced by prior beliefs/preferences. There may also be literature that the decision of what is 'approved' for practice is related to the most powerful voices locally.
Many thanks.
Best wishes,
Denis
Dr Denis Walsh
Associate Professor in Midwifery
Postgraduate Director of Research & Knowledge Transfer Academic Division of Midwifery University of Nottingham A Floor Medical School Queens Medical Centre Derby Rd Nottingham NG7 2UH
Tel: +44(0)115 8230987
Mobile: 07905735777
Email: [log in to unmask]<mailto:[log in to unmask]>
This message and any attachment are intended solely for the addressee and may contain confidential information. If you have received this message in error, please send it back to me, and immediately delete it. Please do not use, copy or disclose the information contained in this message or in any attachment. Any views or opinions expressed by the author of this email do not necessarily reflect the views of the University of Nottingham.
This message has been checked for viruses but the contents of an attachment may still contain software viruses which could damage your computer system, you are advised to perform your own checks. Email communications with the University of Nottingham may be monitored as permitted by UK legislation.
Please consider the environment and think before you print
***************************************************************************************************************
University of the West of Scotland aims to have a transformational influence on the economic, social and cultural development of the West of Scotland and beyond by providing relevant, high quality, inclusive higher education and innovative and useful research.
Visit www.uws.ac.uk<http://www.uws.ac.uk/> for more details University of the West of Scotland is a registered Scottish charity. Charity number SC002520.
***************************************************************************************************************
Legal disclaimer
--------------------------
The information transmitted is the property of the University of the West of Scotland and is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Statements and opinions expressed in this e-mail may not represent those of the company. Any review, retransmission, dissemination and other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender immediately and delete the material from any computer.
--------------------------
------------------------------
End of MIDWIFERY-RESEARCH Digest - 30 Mar 2014 to 31 Mar 2014 (#2014-82)
************************************************************************
|
