While I am a BIG proponent of evidence based practice, it is also a source of frustration for me, especially those who want to wait for “more evidence” when the evidence we already have is sound, makes sense and aligns with our current knowledge of physiology and practice.
One example from a few years back was when a midwife Tomasina Stacey reported findings from her PhD, a case-control study which examined risk factors for stillbirth (Stacey et al 2011). She stated that there was an increased risk of stillbirth if the mother described not settling to sleep on her side. This finding made sense, physiologically, practically and clinically. While some urged caution in adopting those findings into practice without subsequent study, midwives in New Zealand went ahead and started telling women to avoid supine sleep and low and behold there was a drop in stillbirth in that country that many have attributed to midwives telling women to sleep on their side (Mitchell 2015).
Initially New Zealand was the only country in the world where maternity care providers gave this advice, obstetricians in other countries said we needed to wait for more evidence before “worrying women.” Now, almost a decade later, this recommendation has been adopted as one of the elements of the Australian version of the safer baby bundle, better late than never I suppose, but it is sad to think that in the ensuing 10 years many babies lives could have been saved by adopting this simple measure and this delay in adopting evidence into practice and waiting for the definitive study has undoubtably cost lives.
Unfortunately, the same thing is happening again. This time with fetal movement messaging. We currently have a weight of evidence from good case-control and cohort studies that there are three aspects to how the unborn baby moves, these are :
Actually, if you think about it, it isn’t rocket science. Once the baby is born and, in fact, for the rest of our lives we don’t use just one metric to tell us if a person is well or not. In fact, we all know that if a person is unwell they not only move less often, they move less strongly and will also usually change their pattern of daily activities. Frankly I don’t understand why its so very hard to accept the unborn baby does exactly the same thing!
This evidence is from four case-control studies, ironically the same studies that gave us evidence that avoiding supine sleep in late pregnancy is probably a good idea. There has also been a good cohort study that has added evidence for how the well fetus behaves close to term (Bradford 2019). Yet for some reason this evidence hasn’t been accepted, apparently we need more.
Its certainly baffling. The longer we wait to tell pregnant women the whole story, the longer we wont save every baby we possibly can in this country.
Telling the pregnant women that getting to know her unborn baby movements is important and that IF she becomes concerned about any aspect of their behaviour (strength, frequency or pattern) that she should seek care, isn’t anxiety provoking …its empowering. I for one am not prepared to wait for those who think they need more evidence to get with the program, because pregnant women need every shred of evidence we have now to keep their baby safe, NOT evidence that we have cherry picked, NOT evidence we think wont make more work for us, NOT evidence we think is ‘safe’ to share…. ALL of it.
What evidence am I talking about? Here is a summary of what we currently know about other changes in fetal movements:
One example from a few years back was when a midwife Tomasina Stacey reported findings from her PhD, a case-control study which examined risk factors for stillbirth (Stacey et al 2011). She stated that there was an increased risk of stillbirth if the mother described not settling to sleep on her side. This finding made sense, physiologically, practically and clinically. While some urged caution in adopting those findings into practice without subsequent study, midwives in New Zealand went ahead and started telling women to avoid supine sleep and low and behold there was a drop in stillbirth in that country that many have attributed to midwives telling women to sleep on their side (Mitchell 2015).
Initially New Zealand was the only country in the world where maternity care providers gave this advice, obstetricians in other countries said we needed to wait for more evidence before “worrying women.” Now, almost a decade later, this recommendation has been adopted as one of the elements of the Australian version of the safer baby bundle, better late than never I suppose, but it is sad to think that in the ensuing 10 years many babies lives could have been saved by adopting this simple measure and this delay in adopting evidence into practice and waiting for the definitive study has undoubtably cost lives.
Unfortunately, the same thing is happening again. This time with fetal movement messaging. We currently have a weight of evidence from good case-control and cohort studies that there are three aspects to how the unborn baby moves, these are :
- Strength
- Frequency
- Pattern
Actually, if you think about it, it isn’t rocket science. Once the baby is born and, in fact, for the rest of our lives we don’t use just one metric to tell us if a person is well or not. In fact, we all know that if a person is unwell they not only move less often, they move less strongly and will also usually change their pattern of daily activities. Frankly I don’t understand why its so very hard to accept the unborn baby does exactly the same thing!
This evidence is from four case-control studies, ironically the same studies that gave us evidence that avoiding supine sleep in late pregnancy is probably a good idea. There has also been a good cohort study that has added evidence for how the well fetus behaves close to term (Bradford 2019). Yet for some reason this evidence hasn’t been accepted, apparently we need more.
Its certainly baffling. The longer we wait to tell pregnant women the whole story, the longer we wont save every baby we possibly can in this country.
Telling the pregnant women that getting to know her unborn baby movements is important and that IF she becomes concerned about any aspect of their behaviour (strength, frequency or pattern) that she should seek care, isn’t anxiety provoking …its empowering. I for one am not prepared to wait for those who think they need more evidence to get with the program, because pregnant women need every shred of evidence we have now to keep their baby safe, NOT evidence that we have cherry picked, NOT evidence we think wont make more work for us, NOT evidence we think is ‘safe’ to share…. ALL of it.
What evidence am I talking about? Here is a summary of what we currently know about other changes in fetal movements:
As you look at these, tell me if the mother of a young baby reported any or all of the symptoms from the right hand column that you wouldn’t investigate further? !! Likewise if she was telling you symptoms from the left column… you would reassure her…right? Actually, taking that analogy further, no-one would even call for more evidence for this list of symptoms it’s so obvious that the symptoms on the right might indicate a problem and need to be investigated…right??
Come on people its not rocket science, do we actually need to wait for even more studies that are saying the same logical thing or can we use our brains, our common sense and our conscience for that matter and tell women ALL signs she needs to be aware of AND report to keep her baby safe?
Come on people its not rocket science, do we actually need to wait for even more studies that are saying the same logical thing or can we use our brains, our common sense and our conscience for that matter and tell women ALL signs she needs to be aware of AND report to keep her baby safe?
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