Handouts - evidence-based or not, and how/whether to give information

[napualani]

What truly defines "evidence-based"? Aside from sources like Lamaze or Childbirth Connection, where the articles show results from various resources, would "evidence-based" refer to articles that speak about risks and benefits and don't give the author's personal opinion about the subject?

Then there are articles that are written by well-known authors in the field, like Ina May, Penny Simkin, etc. We know their views, but would some of what they talk about be more opinion-based because they also speak from their experiences?

And then there are articles about subjects like Diaper Changing, by Elizabeth Pantley, who talks about the feel-good aspects about changing diapers and how that can be an opportunity for bonding.

My point of this is, as I sift through the wealth of information I find online and gather articles that *I* like, I wonder if I'm overstepping bounds and being biased. There are quite a bit of articles from various journals and such which give lots of numbers and facts, but the material is very dry and uninteresting. Then there are articles that discuss pros and cons, back it up with some cited research that makes sense to me, but it might be written by some random person rather than a formal organization.

I'm probably overintellectualizing this whole thing. There are just so many theories, and just about anyone can throw together some facts and claim their way is healthier for mom and baby, and then get some negative findings to further "prove" their points.

So in terms of creating a binder and whittling down the most vital information, I'm interested to know how some of you determine what is "evidence-based" and worthy to include in your work with your clients. Because as I get deeper into all this stuff, I find it hard to be truly un-biased.

I know this is not having anything to do with birth, but to give an example, I've been asked by clients about co-sleeping and baby-wearing. The information I provided about both topics included the benefits, research that has been done about both, and how to do both correctly and safely. I wouldn't give information that talks about crying it out, but I might offer information about gentler ways to parent baby to sleep without sharing the bed. Am I giving too much of my own opinion here? I didn't communicate that I strongly disagree with one way or another, but I was asked for information that I know a lot about.

Same with breastfeeding...I'm going to present information that will discuss benefits and present information that will, in essence be pro-breastfeeding, even though I'm presenting facts and research and such.

As a doula, if women are asking you about specific subjects or concerns, outside of the medical stuff that is clearly out of our scope of practice, and outside of *birth* do you go ahead and give information if you have an opinion or knowledge about the subject, or do you encourage them to find information on their own? It's been mentioned that many people are looking for resources that address the emotional roller-coaster of pregnancy and labor. I see many wonderful articles that address that very subject, but it might not necessarily be evidence- or research-based.

I think I'm getting myself more and more confused about "educating" in an unbiased way. I'm thinking it's hard to be completely unbiased. Help!

[HerthElde]

These don't all apply, but some do:
http://www.pigstompers.net/murphy-research.htm

RESEARCHMANSHIP

GORDON'S FIRST LAW:
If a research project is not worth doing at all, it is not worth doing well.

MURPHY'S LAW OF RESEARCH:
Enough research will tend to support your theory.

MAIER'S LAW:
If the facts do not tend to conform to your theory, they must be disposed of.
Corollaries:
1. The bigger the theory, the better.
2. The experiment may be considered a success if no more than 50% of the observed measurements must be discarded to obtain a correspondence with the theory.

WILLIAM'S AND HOLLAND'S LAW:
If enough data is collected, anything may be proven by statistical methods.

EDINGTON'S THEORY:
The number of different hypotheses erected to explain a given biological phenomenon is inversely proportional to the available knowledge.

PEER'S LAW:
The solution to a problem changes the nature of the problem.

HARVARD LAW:
Under the most rigorously controlled conditions of pressure, temperature, volume, humidity, and other variables, the organism will do as it damn well pleases.

FORTH LAW OF REVISION:
After painstaking and careful analysis of a sample, you are always told that it is the wrong sample and doesn't apply to the problem.

HERSH'S LAW:
Biochemistry expands to fill the space and time available for it's completion and publication.

RULE OF ACCURACY:
When working toward the solution of a problem, it always helps if you know the answer.

YOUNG'S LAW:
All great discoveries are made by mistake.
Corollary:
The greater the funding, the longer it takes to make the mistake.

HOARE'S LAW OF LARGE PROBLEMS:
Inside every large problem is a small problem struggling to get out.

FETT'S LAW OF THE LAB:
Never replicate a successful experiment.

WYSZOWSKI'S FIRST LAW:
No experiment is reproducible.

FUTILITY FACTOR:
No experiment is ever a complete failure- it can always serve as a negative example.

MR. COOPER'S LAW:
If you do not understand a particular word in a piece of technical writing, ignore it. The piece will make perfect sense without it.

PARKINSON'S LAW FOR MEDICAL RESEARCH:
Successful research attracts the bigger grant which makes further research impossible.

PARKINSON'S SIXTH LAW:
The progress of science varies inversely with the number of journals published.

WHOLE PICTURE PRINCIPLE:
Research scientists are so wrapped up in their own narrow endeavors that they cannot possibly see the whole picture of anything, including their own research.
Corollary:
The Director of Research should know as little as possible about the specific subject of research he is administering.

BROOKE'S LAW:
Whenever a system becomes completely defined, some damn fool discovers something which either abolishes the system or expands it beyond recognition.

CAMPBELL'S LAW:
Nature abhors a vacuous experimenter.

MESKIMEN'S LAW:
There is never time to do it right, but there is always time to do it over.

[Stacie]

Cochrane is an excellent source of info.

[HerthElde]

I realized the point of my above post might not be obvious. Sorry! The point is, as objective as we want to believe "evidence-based information" is, when it comes right down to it, it's still at least a little bit subjective (often based on subjective assumptions, for example).
If your objective info seems too subjective for someone, it probably isn't a good fit anyway.

[syncreo]

Excellent source of info is "A Guide to Effective Care in Pregnancy and Childbirth" it is a book but you can also get downloaded versions of the chapters at the Childbirth Connection website.

[syncreo]

Here is a link to a whole list of evidence-based research related to pregnancy, birth and beyond:

http://www.lamaze.org/ChildbirthEduc...0/Default.aspx

[doula Michele]

That has always been my question. There is evidence for absolutly everything, and a study too. All depends what side of the fence you happen to be on.

[syncreo]

If you keep up to date on research though and you are able to sift through the garbley gook to make sense of it there are clear indications and some vaguer indications on most issues. Yes, anyone can make a case for any issue but the soundness of the arguement is based on whether it is grounded in current research or their own opinons or someone else's opinion disguised as research

That is why I love "A Guide to Effective Care in Pregnancy and Childbirth" because i it compiles the research for you and gives you the summary of what it all means for different issues.

[Jeanette]

Quote:

Originally Posted by doula Michele There is evidence for absolutly everything, and a study too. All depends what side of the fence you happen to be on.

Maybe it's just my perception, but that statement is absolutely untrue. I have searched for hours sometimes to find research on google scholar on certain topics and come up with nothing that addresses my question. I would feel like a liar if I told anybody that research and studies exist for each and every question out there. That's false.

No matter how hard we try, we will be biased. If we are aware of that and keep it in mind we will be better doulas for our clients. I don't apologize for my bias, and neither do the researchers who perform studies. We all carry around our own personal beliefs and experiences, and our clients do the same thing. They are being shown bias by all of their care providers and they'll pick and choose what they want to listen to based on their beliefs and personalities.

[MothertheMother]

Darelene, I completely get what you are saying. I don't think there is any way to be completely unbiased when it comed to educating clients. You can support choices that may not be yours but I don't know if you can really be unbiased with the information (well, some of it maybe but not always all of it) you present. Most of us have read and read and read and would never expect pregnant mama's to comb through all of the books, articles, websites, studies we've already been through to come to their own conclusions. I would like to believe that I have read enough evidence-based stuff to feel comfortable passing on an article that is actually interesting (ie not all studies and numbers) to my clients that supports the same beliefs. I would love for all of my clients to research any and all topics about pregnancy but I am realistic that most just won't do that. If I come across an article or story that I feel makes a great point and is an interesting read I'll definitely add it to my binder. But I also like to add websites and book titles in the back of each section of my binder so clients can read further on a subject if they are inclined. Now, if the client is actually facing a specific issue I'd definitely want to keep the info evidence-based and I would want her to research it herself or she'd never feel empowered to make decisions about her care that might go against the norm.

I guess my opinion is if they will read it, put it in! I also like to forward an article at a time via email here because I think they pay more attention when not overwhelmed with information.

phone: I'll write more in a bit

Christy

[dreamharderila]

My only thought on this is that a client hires you based on how you "mesh" with her and her ideas. More than likely a client has some of the same perceptions, and whatever you show her, she is more than likely going to agree with. But just to be safe, maybe when a client asks for info about something you dont particularly agree with, you can ask them what it is that they want. Such as the pros, cons, or just how to. If you know exactly what it is that they want to learn, then you will be better able to provide the information they request.
If a client asked me for information on inductions, I would want to know what it is that they are looking for. Do they want to know the medical reasons to have one, the problems that can occur with one, or just info about what it is. Or perhaps they just want info on how to naturally stimulate labor. As long as I ask a couple questions, I will know exactly what info to pass on. No bias that way.
Ila

[Raven]

I work in the pharmaceutical industry so, to me, the term 'evidence-based' means something slightly different.
For me, to say that a piece of work is evidence-based means that its hypotheses, methods of collecting and analysing data, its discussions and conclusion are robust and constructed in such a way as to be as objective as possible. Of course, people can make spurious claims that their work shows X,Y & Z; of course statistics can be manipulated - the point of a robust piece of evidence-based research is that every attempt has been made to to eliminate those very issues.
The other side of this is that no research should ever be taken at face value. It should always with evaluated with a critical eye. This is what Cochrane set out to do and they don't always get it right.
What it means for any one needing health care is that the care they receive should be founded on tried and tested treatments and practice and not just what the provider thought might work well today.
This is why any one receiving any sort of health care is perfectly within their rights to challenge health care providers by asking them for valid, evidence-based reasons for the care they give. All recipients of health care should be challenging health care practices if they are not happy with them. This is one of the best ways of keeping health care at the cutting edge.
So when you're reading anything to do with health care, ask yourself, from where has the author sourced her material?; are those sources valid themselves?; if this is original work then how robust is it?; does it stand up to critical evaluation?
Don't just accept anything that is said or written as valid - it may not be as robust as the author would have you believe.
<Leaps off her soap-box and disappears into the sunset!.....>

Kath