Discuss the importance of research within midwifery, both in terms of appreciating and evaluating available papers and how the evidence is applied to practice. Pressure has increased on health care professionals, via government directives such as the National Health Service Plan (DOH 2002) and Fitness for Practice (UKCC 1999), to provide evidence based care. These directives are aimed at improving outcomes, reducing health inequalities and increasing client satisfaction (Page, 1996). Making a Difference (DOH 1999) states that "Further research activity and systematic review within midwifery are essential to underpin both education provision and practice development. Such work will provide a strong ethos of enquiry within midwifery and facilitate a robust approach to both quantitative and qualitative research". The Nursing and Midwifery Council (2002) Code of Professional Conduct informs of the responsibility of midwives to "deliver care based on current evidence".For the purpose of this essay and in order to discuss research methods and relevance to practice more succinctly, a specific topic has been chosen for investigation. The subject is that of caseloading or one-to-one midwifery, where, as defined by Page et al (2000), a midwife will be responsible for and provide most of the care for a woman and her family for the duration of her pregnancy and into the puerperium. This subject has great relevance to practice. The provision of maternity care has undergone many changes since the middle of the last century.
The 1946 National Health Act initiated the institutionalisation of childbirth and various consecutive government reports encouraged hospital based maternity care with improved outcomes supporting the belief that childbirth was dangerous (Audit Commission, 1997). Walton and Hamilton (1995), highlighted the dissatisfaction of women and midwives with dictated midwifery care, with the wellbeing of the fetus being of primary concern.
[...] By using the above search terms whilst searching in individual journals such as the British Journal of Midwifery and Midwifery many articles were found, both research and non-research. The University also provides databases on its website. Ebscohost, Science Direct and Blackwell Synergy provide access to a vast range of articles. The Cochrane Library (again available on the University library website) provides access to reviews of existing research, collated into concise papers. Internurse is another database that allows entry into a wide selection of midwifery journals. [...]
[...] The North Staffordshire Changing Childbirth Research Team in their 2000 study, aimed to evaluate caseload midwifery in comparison with traditional shared-care. Their outcome measures looked at known carer present at delivery, normal vaginal delivery and obstetric intervention rates. Their design was a comparative study with area randomisation. The design is non- experimental as it does not attempt to exert control. They have used a comparative design comparing results between one cohort and another to see if differences exist between the outcomes. [...]
[...] Having considered that qualitative research is a holistic approach, aiming to describe an event and concerned with feelings (Clarke and Jack, 1998), quantitative research, in contrast, attempts to quantify data, using a hypothesis. The approach uses large samples, representative of the population but not allowing for measurement of experiences (Jack and Clarke, 1998). The term ‘quantitative' literally refers to something ‘capable of being measured' and, as such, people taking part in quantitative studies may be asked questions to which responses are restricted to ‘yes' or ‘no'. [...]
[...] Principles and Practice of Research in Midwifery. Edinburgh: Bailliere Tindall, 113-129. BLUFF, R. and CLUETT, E Critiquing the literature. In E. CLUETT AND R. BLUFF, eds. Principles and Practice of Research in Midwifery. Edinburgh: Bailliere Tindall, 179-196. BLUFF, R., and HOLLOWAY, I ‘They know Best': Women's perceptions of midwifery care during labour and childbirth. In: Midwifery 157-164. CLARKE, A,M,. and JACK,B The Benefits of using Qualitative Research. In: Professional Nurse 13(12) 845-847. CLIFFORD, C Nursing and Health Care Research: A Skills Based Introduction. [...]
[...] Data collection in non-experimental research invariably uses the survey method (Wagstaff, 2000). Such method normally uses questionnaires for data collection, where cost can be minimised and a large geographical area be covered (Wagstaff, 2000). Disadvantages include poor design, which may influence success rates (Rees p79-90). Poor design may also result in researchers not actually getting the data they require (Meadows, 20003b). Results also depend on participants being able to read and answer the questions truthfully (Rees p79-90). Furthermore, response rate may be low with consequent impact on population representation (Rees p79-90). [...]
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