Until relatively recently, a lot of routine maternity care was based on the past and on the opinions of individual practitioners. When researchers started to look at this, they found that some of it was not beneficial and could even be harmful for women, babies or both (many women and midwives had known this all along). For example, studies have consistently shown that electronic fetal heart monitoring does not improve babies’ outcomes, but increases caesarean section rates (Small, 2021). As Sara Wickham points out, more recently, 'evidence-informed practice' has become the accepted approach in health care services. 'This means we use the results of well-designed research studies to inform the treatments and interventions offered to those seeking care' (Wickham, 2021). Of course, the findings of well-designed research studies are invaluable but they can only tell us about populations or certain groups of people. They can’t tell us about individuals. Health practitioners are charged with providing information and advice based on the best evidence available, but no matter what research findings or health practitioners tell us, each of us will have our own unique circumstances, values and experiences and have the right to follow advice or make our own decisions (Beech, 2021).
As so much research is carried out and published and findings often become outdated, we decided not to highlight any particular research findings on this website. Instead, we want to point you towards organisations and people who examine research findings and make their results available on their websites: the Cochrane library of reviews, the National Institute for Health and Care Excellence (NICE) guidelines, and Sara Wickham’s and Rachel Reed’s blog posts are good starting points.
NICE and COCHRANE REVIEWS
In Scotland, there is also the Scottish Intercollegiate Guidelines Network (SIGN) at https://www.sign.ac.uk/ but it has published only a small number of guidelines to do with childbearing. NICE guidelines generally inform policies and practices in maternity care which health practitioners usually follow. These are often informed by the findings of the Cochrane reviews or other reliable evidence – but not always. For example, NICE published draft guidelines for induction of labour in May 2021 and received feedback from many researchers, practitioners and birth activists pointing out that these were not based on sound evidence (https://www.sarawickham.com/articles-2/nice-guideline-on-inducing-labour/). Where research findings are unavailable because the research simply hasn’t been carried out, recommendations might rely on the opinions of experienced practitioners. You can always ask practitioners for the research findings on which their advice and recommendations are based.
Cochrane reviews can be found at https://www.cochranelibrary.com/. These cover a wide range of health concerns including childbirth. They examine medical, midwifery and complementary interventions and approaches.
The Cochrane reviews are generally considered to be the gold standard in research from a bio-medical perspective (https://www.sarawickham.com/articles-2/cerridwyn-and-the-pixies-a-holiday-fairytale/). Each review is usually carried out by several researchers. They collect all relevant research for the topic under review, decide which studies to include, and extract the information they need. Each review includes their findings and a Plain English summary of the these and what they mean. The reviews mainly look at quantitative outcomes – that is, outcomes that can be defined and measured, such as mortality (death) rates, how many babies were admitted to a Special Care Baby Unit and so on. Recent reviews have begun to look at qualitative outcomes, such as what women thought about an intervention. Fortunately, researchers are increasingly expected to look at what women think about any intervention or approach that they are examining.
The reviewers also now include whether they thought that the research studies they used were of low, medium or high quality. In other words, they tell us whether their findings are likely to be reliable or not. It is well worth having a look at how the reviewers rated the research studies they examined, to see how reliable their findings are likely to be.
Other sources of information
Any research has practical as well as contextual limitations – even the Cochrane reviews. Some of these might be obvious, such as when studies are included that are so old that practice has changed beyond recognition, but some are not. For example, some studies examine a rare outcome without having enough people involved to be able to do this. Some reviewers may be more experienced and skilled than others. Where the research took place might make a difference to the outcomes and so on – see Birth Practice and Politics for an article on research problems.
Others have pointed out that research findings can be less reliable than we assume for various reasons – Sara Wickham's article here is useful on the subject – as is this blog from the BMJ and this page from Rachel Reed.
It can be extremely helpful to read good analyses of research findings, that draw on evidence from different kinds of informative studies and that look at the context around these. For reliable analyses of research findings on a range of childbearing related topics, both research midwives Sara Wickham (www.sarawickham.com) and Rachel Reed (www.midwifethinking.com) provide accessible information that acknowledges the complexities of research. They not only provide crucial context for some of the findings of the Cochrane and other research studies, but look at these from the woman’s and the midwives’ perspectives.