Evidence Based

Practice
in Midwifery

Kristen Graham
Adjunct Lecturer in
Nursing & Midwifery

College of Nursing &

Health Sciences,
Flinders University
Presentation outline

• What is Evidence Based Practice?

• The importance of EBP.
• Midwifery Evidence
• Barriers and enablers for
translating of evidence into
practice
Midwifery as an art
and a science

Ancient Roman relief carving of a midwife. Wellcome M0003964.jpg

https://commons.wikimedia.org/wiki/File:Ancient_Roman_relief_carving_of_a_midwife_Wel https://commons.wikimedia.org/wiki/File:A_complete_practice_of_midwi
lcome_M0003964.jpg fery_Wellcome_L0061025.jpg
What is Evidence Based
Practice (EBP)?
Evidence-Based Practice is :

'a problem-solving approach to the delivery

of health care that integrates the best
evidence from studies and patient care
data with clinician expertise and patient
preferences and values.
When delivered in a context of caring and
in a supportive organizational culture, the
highest quality of care and best patient
outcomes can be achieved’.

Melnyk et al (2010)
Research Evidence

Evidence
Clinical Expertise Based
Practice

Patient values &

preference
Importance of EBP in
Midwifery Practice
• Informs policy and practice
• Ensures women receive care that meets
their needs
• Facilitates sound decision making and
minimises risks
• Reduces unnecessary, ineffective and
possibly harmful interventions
• Provides justification for clinical decisions
and actions
• Builds professional body of knowledge and
professional integrity

(Spencer, 2018; De Leo et al, 2019)

MIDWIFERY REGULATION, STANDARDS &
PRIORITIES

Midwifery Council
(Indonesian Health Workers Council)
ICM Essential Competencies for Midwifery Practice

(ICM, 2018)
EBP in the ICM
competencies
The ICM competencies promote:
• the autonomy of midwives to practise within the full scope of midwifery
practice and in all settings
• the role of the midwife to support physiology and promote normal birth
• the role of the midwife to uphold human rights and informed consent
and decision making for women
• the role of the midwife to promote evidence-based practice, including
reducing unnecessary interventions
• the role of the midwife to assess, diagnose, act, intervene, consult and
refer as necessary, including providing emergency interventions.
 Preparing
midwifery students
As educators, we must support
students to develop professional
knowledge, skills and attributes to
be workforce ready – competent
in the provision of safe, effective
and professional midwifery care –
ALL reflecting
EVIDENCE BASED PRACTICE
MIDWIFERY
EDUCATION
PRIORITIES
&
GUIDANCE

Source: www.who.int/hrh/nursing_midwifery/13012WHO_Midwifery_educator_core_competencies.pdf
Evidence Based Practice 5 Steps
‘Step 1: Formulating a well-built question
Step 2: Identifying articles and other
evidence-based resources that answer
the question (finding the evidence)
Step 3: Critically appraising the evidence to
assess its validity
Step 4: Applying the evidence
Step 5: Re-evaluating the application of
evidence and areas for improvement’
(CQUniversity Library, EBP Steps.
https://libguides.library.cqu.edu.au/ebp#s-lg-box-17229445)

Photo source: https://blogs.flinders.edu.au/fit/wp-

content/uploads/sites/19/2020/04/online-learning.jpg
Evidence Hierarchy
Not all evidence is equal,
and not all evidence is
appropriate to inform
practice and policy.
Evidence has been ranked
by health scientists,
academics and clinicians
according to its quality, as
evident in this hierarchical
pyramid framework.

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 Evidence Based
Midwifery Practice
• Models of maternity care
• Infection Control – COVID 19
• Medication administration
• Fetal monitoring
• Nutrition in labour
• Pain relief in labour
What impacts
integration of evidence
into practice?
• No perceived reason to change: ‘This
is the way we have always done it
and it works!’
• Perceptions that change is too
difficult
• Time and budget constraints
• Inter-professional resistance to
change
(De Leo et al, 2019)
 Translating Evidence into
Midwifery Practice
• Promote a workplace culture which:
• Embraces evidence and best practice
• Empowers midwives and nurses
• Integrate evidence into policy and
guidelines
• Provide clear communication of
changes, evidence & expectations
• Provide appropriate resources to
implement EBP
• Provide evidence of improvements of
patient outcomes achieved through EBP
(Kueny et al, 2015)
The Triangle
of Wisdom for
Midwifery
Practice
Hannah Dahlen, 2019
‘Dancing in the grey zone between normality and risk’
Now more than ever the
world needs skilled
midwives to provide
woman-centred care and
provide leadership in best
practice and improving
health outcomes for
women and babies. https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.who.int%2Fcampaigns
%2Fyear-of-the-nurse-and-the-midwife-2020%2Fget-involved%2Fcampaign-
materials&psig=AOvVaw1z6OynSMl0oCXXrWgM40gP&ust=1592561984883000&sourc
e=images&cd=vfe&ved=0CAIQjRxqFwoTCJDRwbaRi-oCFQAAAAAdAAAAABAD
Terima kasih
Questions/Discussion
References & Resources
CQUniversity Library, EBP Steps. https://libguides.library.cqu.edu.au/ebp#s-lg-box-17229445

Dahlen, H. (2019). Chapter 4. Fear and risk. In: Pairman, S., Tracy, S., Dahlen, H & Dixon, L.(eds). Midwifery Preparation for Practice 4e. Elsevier
Australia.
De Leo, A., Bayes, S., Geraghty, S., & Butt, J. (2019) Midwives’ use of best available evidence in practice: An integrative review. Journal of Clinical
Nursing, 28(23-24), 4225-4235. https://doi.org/10.1111/jocn.15027
International Confederation of Midwives. (2018). Essential Competencies for Midwifery Practice. 2018 Update.
https://www.internationalmidwives.org/assets/files/general-files/2018/10/icm-competencies---english-document_final_oct-2018.pdf
Luyben, A., Fleming, VJones, T. (ed). (2013). Clinical Reasoning. Learning to think like a nurse. Frenchs Forest, NSW: Pearson Australia., & Vermeulen,
J. (2020). Midwifery education in COVID-19 time: Challenges and opportunities. Midwifery, 89: 102776. doi: 10.1016/j.midw.2020.102776
Kueny, A., Shever, L., Mackin, M., Titler, M. (2015). Facilitating the implementation of evidence-based practice through contextual support and nursing
leadership. Journal of Healthcare Leadership, 7, 29-30. doi: 10.2147/JHL.S45077
Melnyk, B., Fineout-Overhold, E., Stillwell, S., & Williamson, K. (2010). Evidence-based practice: step by step: the seven steps of evidence-based
practice. American Journal of Nursing, 110(1), 51-53. DOI: 10.1097/01.NAJ.0000366056.06605.d2
Spencer, R. (2018). Embedding evidence-based practice within the pre-registration midwifery curriculum. British Journal of Midwifery, 26(5).
https://doi.org/10.12968/bjom.2018.26.5.338
World Health Organization. (2013). Midwifery educator core competencies.
https://www.who.int/hrh/nursing_midwifery/13012WHO_Midwifery_educator_core_competencies.pdf