Evidence Based Midwifery - take care to mind the gap

Evidence Based Practice (The categories described by Graham et al 2006)

knowledge use —> use of the evidence underpinning the practice EXAMPLE behaviour change

impact —> what results improved from the knowledge EXAMPLE service user/patient outcomes, cost effective delivery of care

Practice has been changed when

Evidence of harm has been presented

The hidden consequences of routine epistiotomy

discomfort, sexual and psychological health, relationships with her infant,families and friends ← these outcomes were rarely considered

Evidence that EBM is implemented

Episiotomy rates in the UK are around 14%

Things that were/weren’t considered in reducing episiotomy

Considered: Reducing routine episiotomy as a consequence of evidence of harm was considered and necessary

Not Considered: Whether there was an optimal rate of epistiotomy

• Impacts of change of epistiotomy practice in midwifery management of the perinium

What should be considered in the scenario of reducing routine epistiotomy? (outcome wise think if it was implented)

Potential consequences of reversing the practice

current research to address midwifery skills in perineal assesment has highlighted a lack of confidence amongst midwifes of when and how to perform an epistiotomy

A potential outcome is a women who could have benefitted from an epistiotomy could sustain more severe perineal trauma as their midwife may have not felt sufficiently informed to make a decision and intervnee