Julia Sanders Professor of Clinical Nursing and …...Myles Textbook for Midwives, 11th Ed. 1989...
Transcript of Julia Sanders Professor of Clinical Nursing and …...Myles Textbook for Midwives, 11th Ed. 1989...
Julia Sanders
Professor of Clinical Nursing and Midwifery FRCM, RN, RM, ADM, LLM, MPH, PhD
Evidenced based practice
… Lots to learn
… Lots to do
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Textbooks describe midwifery care over the
decades…
Including progress towards evidenced based
practice.
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
‘Research’ first appeared in the 11th Edition of Myles
Textbook for Midwives in 1998
Myles Textbook for Midwives, 11th Ed. 1989
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Myles Textbook for Midwives, 3rd Ed. 1959
Shaving TrayThe razor blade should be sharp, the pubic hair well
lathered with green soap and the shaving strokes made in a downward direction to avoid
unnecessary pain.
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Myles Textbook for Midwives, 3rd Ed. 1959
Shaving TrayThe razor blade should be sharp, the pubic hair well
lathered with green soap and the shaving strokes made in a downward direction to avoid
unnecessary pain.
EnemaIt is preferable that every
woman should have her lower bowel opened at the beginning of labour.
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Myles Textbook for Midwives, 3rd Ed. 1959
Shaving TrayThe razor blade should be sharp, the pubic hair well
lathered with green soap and the shaving strokes made in a downward direction to avoid
unnecessary pain.
EnemaIt is preferable that every
woman should have her lower bowel opened at the beginning of labour.
BathThe question as to whether the
woman in labour should be permitted to have a tub bath,
because of the risk of bath water entering the vagina, is highly
controversial. From a practical point of view it has much to
recommend it : otherwise it is difficult to remove all the short
cut hair after shaving.
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
1981 Romney & Gordon Enema study (BMJ ) N=274 Initial resistance from midwives to randomise women.Observational study of 224 women (with / without enema, combined with 50 women randomized.Following 50 women randomised midwives were again opposed to randomising women as they felt the results were already clear.
Drayton & Rees 1984 N=222 RCT Published in the Nursing Mirror as the BMJ did not accept non-medical authors.
1987 Sally Garforth & Jo GarciaBaths, Shaves and Enemas still commonplace
Enema Trials
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
2018 – WHO
Routine perineal / pubic shaving prior to giving vaginal birth is not recommended.
Administration of enema for reducing the use of labour augmentation is not recommended.
Enema Trials … 30 years on
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Early labour care …
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Care in the latent phase of labour..
Is encouraging women to remain at or return home always best?
“You are welcome to come in for assessment but if you are not 4cm we will send you home again”
What constitutes delay in the latent phase and how should it be managed?
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
1990’s trials of antenatal care schedules
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
1990’s trials of antenatal care schedules
There is still a lack of evidence around postnatal care schedules.
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
1989 Know your midwife scheme
Photos: ©Corry Bevinton
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
1989 Know your midwife scheme
Photos: ©Corry Bevinton
Developing sustainable continuity models remains a real challenge.
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Restrictive n=498Episiotomy rate 10%
Liberal n=502Episiotomy rate 51%
Primiparous 36 (17.9%) 147 (67.1%)
Multiparous 15 (5.1%) 111 (39.2%)
“These findings provide little support either for liberal use of episiotomy or for claims that reduced use of the operation decreased postpartum morbidity”
A priori sample size calculationIntention To Treat analysis10 day & 3 month follow-up response rate 89%
19% of women had urinary incontinence 3 months post delivery
2/1,000 OASI
Liberal v selective episiotomy Published 1984
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Restrictive n=498Episiotomy rate 10%
Liberal n=502Episiotomy rate 51%
Primiparous 36 (17.9%) 147 (67.1%)
Multiparous 15 (5.1%) 111 (39.2%)
“These findings provide little support either for liberal use of episiotomy or for claims that reduced use of the operation decreased postpartum morbidity”
What is the best care in the second stage to minimize OASI?
Perineal wound care.
How should labial trauma be managed?
Liberal v selective episiotomy Recruitment 1982 Published 1984
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
NICE September 2007
‘We do not have enough
information about the possible
risks to either the woman or
her baby relating to planned
place of birth.’
“The Royal College of Midwives and the
Royal College of Obstetricians and
Gynaecologists (RCOG) support home
birth for women with uncomplicated
pregnancies. There is ample evidence
showing that labouring at home
increases a woman’s likelihood of a
birth that is both satisfying and safe.”
RCOG / RCM Joint Statement April 2007
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Birthplace in England Study
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
With the increase in Midwifery Led unit care are our outcomes the same as Birthplace?
Birthplace in England Study
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Why the differences and how can they be minimized?
Birthplace in England Study
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Environment matters … But how?
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
BUMPES Trial – Getting evidence into practice
remains a struggle … (sometimes)
BUMPES Awarded 2018 BMJ Research paper of the year
Significantly fewer spontaneous vaginal births occurred in women in the upright group: 35.2% compared with 41.1% lying down group. aRR 0.86 (95%CI 0.78 to 0.94)
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Significantly fewer spontaneous vaginal births occurred in women in the upright group: 35.2% compared with 41.1% lying down group. aRR 0.86 (95%CI 0.78 to 0.94)
Is this fully integrated into your practice?
BUMPES Trial – Getting evidence into practice
remains a struggle … (sometimes)
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
The (big) issue that needs more attention – staff wellbeing
Previously conducted in Australia, New Zealand, Sweden, Canada and Norway.
N=1997 Online survey May – July 2017
Over one third of participants scored in the moderate/severe/extreme range for stress (36.7%) anxiety (38%) and depression (33%).
This was well above population norms and those of other WHELM countries.
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Previously conducted in Australia, New Zealand, Sweden, Canada and Norway.
N=1997 Online survey May – July 2017
Over one third of participants scored in the moderate/severe/extreme range for stress (36.7%) anxiety (38%) and depression (33%).
This was well above population norms and those of other WHELM countries.
What working arrangements give the best outcomes for mothers, babies and staff?
How can we best support newly qualified midwives?
The (big) issue that needs more attention – staff wellbeing
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
The (big) one we missed …
Abi and baby Esme (with permission)
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Plenty to do….
Labial trauma
Postnatal perineal care
Latent Phase
Breastfeeding maintenance
Pelvic pain in pregnancy
Postnatal care schedules
Identification of the ‘truly’ infected mother / baby
Intermittent Auscultation
Birth related psychological trauma
Environment of birth
Optimal size and organisation of maternity units
And ….
Cracking sustainable continuity models ..
Photo Leah Millinshiphttp://www.leahphotography.co.uk/
Wales & South West Maternity & Midwifery Festival 2019Julia Sanders, Professor of Clinical Nursing and Midwifery
Plenty to do…. Have fun and work hard
To further improve care for mothers and babies