24h-payday

Archive

Archive for May, 2010

‘Tis the (Conference) Season: Come share, connect, and learn along with me

May 31st, 2010 by avatar

I have felt a little bit like a slacker blogger lately, but it’s not for lack of thinking and writing about birth. I just wrapped up an article called Social Media, Power, and the Future of VBAC with Hilary Gerber from Mom’s Tinfoil Hat and Desirre Andrews from Preparing for Birth which we submitted to the 50th anniversary “Looking Back – Looking Forward” special issue of Lamaze’s Journal of Perinatal Education. I’ve also been working with Kristen Oganowski from Birthing Beautiful Ideas to coordinate the development of an NIH VBAC Statement Primer for consumers. We have a bunch of brilliant contributors on board and will be launching the primer later this month at Lamaze’s new (very cool!) social networking site for women, Giving Birth with Confidence.

Now the big looming work comes in the form of conference season. And I want you (yes YOU) to help me. I have a love-hate relationship with conferences. Mostly love. I love how much sharing, connecting, and learning happens. I love finding out what old friends and colleagues are up to and meeting the people doing the most interesting, innovative, and important work in the field. But attending (and especially speaking at) a conference is a lot of work, and often disrupts progress in my other (equally if not more important) work. Also, I hate that conferences take me away from my family.

So…I want to make the most of the opportunities these conferences offer. I want to maximize the amount of sharing, connecting, and learning we – collectively – do. And I want to leave these conferences not with tons of new projects and commitments for myself, but with tons of new opportunities for the broader maternity care community (that means YOU) to drive meaningful improvements for women, infants, and families.

Here’s some more about the conferences I’m attending, and how YOU can be part of them.

On June 7 I’ll be at Health 2.0 Goes to Washington.

Health2ConDC

Um, have I mentioned lately that I think social media is going to transform maternity care? Well I developed this delirious optimism by hanging around (online) with the Participatory Medicine crowd.  I get to actually meet most of them next week!

I first caught on to the Participatory Medicine train when I read a Grand Rounds blog carnival on the theme of “Meaningful Use” almost exactly a year ago. “Meaningful Use” is government speak for the goal of implementing electronic health records (with piles and piles of stimulus money) in a manner that actually improves care. The Participatory Medicine folks are front and center in the conversation, pushing for patient-access to be the defining characteristic of meaningful. It’s all about liberating the mounds of data that will exist in electronic health records and letting innovators, policy-makers, scientists, and – most importantly – patients themselves use that data to improve health.

I have 10 minutes to speak but a whole day to connect and learn.  Here are my questions for you to help me make the most of this opportunity:

  1. What do you think are the most innovative ways women are using the internet or social media to have healthier, safer, and more satisfying childbearing experiences?
  2. What are the types and sources of maternity care data that you would most like to see become available?
  3. What kind of data do you think should be documented in electronic health records during pregnancy, birth, and the postpartum and newborn period? Think outside the box.
  4. What do you think would be the most important benefits (and for that matter, risks or drawbacks) of having complete, unhindered, timely access to your maternity care records?
  5. What ongoing or forthcoming projects in the maternity care world could use the insights or funds of outside (non-birth-enthusiast) social innovators?

The following week (June 12-16), I’ll be at the American College of Nurse-Midwives Annual Meeting.

ACNM

I’m only attending ACNM for one day, but traveling with my family for my kids’ first-ever trip to the nation’s capitol.  I’m giving two educational sessions that couldn’t be more different from one another. First, I’m presenting a talk called, “How Not to Get Duped by Obstetric Research” about the importance of thinking critically about evidence, and how honing critical analysis skills can can help midwives practice and advocate for safe and effective care. The other talk is a panel discussion with Amie Newman from RH Reality Check and Mary Murry, CNM, from The Mayo Clinic “Pregnancy Week by Week Blog,” moderated by Melissa Garvey from ACNM’s own Midwife Connection Blog. We’ll be talking about why more midwives should be blogging and how they can get started.  We recorded a really lively discussion about these issues on The Feminist Breeder & Friends Radio Show on International Day of the Midwife – a preview of our ACNM panel – which you can listen to here:

My questions for YOU:

  1. What do you think is the optimal role of midwives (specifically certified nurse-midwives and certified-midwives) in blogging and other social media?
  2. How can we protect the privacy and dignity of the women and families we serve (and for that matter, the people we work with) when midwives share about our work in social media spaces?
  3. What obstetric routines or beliefs would you most like to hear me critically analyze?  I promise to make at least a blog post or two out of my How Not to Get Duped talk. (Actually, what I’ll also do is write parts of the talk from my prior blog posts, so if you have any favorite posts from the archives that you think would make good case studies, please suggest them!)
  4. What are the best DC outings to do with a 3 and an almost-6 year old? :)

Lastly but Oh-So-Not-Leastly, I’ll be attending the Normal Labour and Birth 5th International Research Conference in July.

Normal Birth

I’m not speaking at this conference. I’m going for the sole purpose of blogging it! I wrote a proposal to the conference organizers suggesting that they let me attend and help disseminate the proceedings. They agreed!  I think this is a huge opportunity to learn from the people doing the research about how to optimize the health and safety of healthy women and their babies around the time of birth. We’ll also hear from leaders who are creating and maintaining integrated, midwife-led primary maternity care systems, the gold standard for achieving “woman-centered, safe, effective, timely, efficient, and equitable” care.

What happened when bloggers and other connected consumers attended the NIH Consensus Development Conference on VBAC was astounding and continues to deliver. Since that experience, I’m addicted to putting scientific findings in the hands of engaged, connected consumers, because, as Kay Dickerson from the Cochrane Collaboration says, “We’ll only get evidence-based healthcare in this country through consumer activism.” Today activists have more access than ever before to information and are getting increasingly social media savvy. There’s no telling what we can do if we put our innovative, passionate minds to it and work collaboratively.

So here’s what I want to know from YOU:

  1. Whose research are you most interested in hearing about? (Look over the Normal Labour and Birth agenda to see who will be presenting about what.)
  2. Would you rather have a little bit of information/analysis about more of the presentations or more in-depth analysis of fewer presentations?
  3. Are there any researchers you would like me to conduct a “Consider the Source” Interview with?

Finally, any readers who are planning to attend any of these conferences – I invite you to submit a guest post. I’d love to share multiple perspectives (not to mention the tremendous work of blogging all of these meetings!) Just email me at amyromano [at] Lamaze [dot] org.

Uncategorized , , , , , , , , , , , , , ,

Calling all bloggers! Healthy Birth Blog Carnival #6: Motherbaby edition

May 25th, 2010 by avatar

Keeping birth healthy and safe doesn’t end when the baby is out. Skin-to-skin contact, the beginnings of emotional attachment, the mother’s physical recovery, and the initiation of breastfeeding are the continuum of biological processes that began in pregnancy and labor. We’ve reached number six in our six-part series of Blog Carnivals. And this one is about keeping moms and babies together after birth.

That’s right – this is the last Healthy Birth Blog Carnival! The Carnivals, to me, represent the huge amount of information, support, and woman-to-woman collaboration the internet now offers to support safe and healthy birth. I’ve loved reading all of your stories, hearing diverse perspectives, and working together to generate a new understanding of the type of care that moms and babies deserve. I know I am in for some delightful and insightful reading – and some heartbreaking stories, too.

You can submit anything that relates to the care and support of mothers and babies after birth. Here are some resources from Lamaze International to get you started:

Participation in the Healthy Birth Blog Carnival is easy:

1. If you are a blogger, write a blog post on the Carnival theme. Post it on your blog by Friday, June 11. Make sure the post links back to this blog post, to the Healthy Birth Practice Paper, or to the video above. You may also submit a previously written post, as long as the information is still current.

2. Send an email with a link to your post to amyromano [at] lamaze dot org.

3. If you do not have a blog but would like to participate, you may submit a guest post for consideration by emailing it to me.

4. I will compile and post the Blog Carnival at Lamaze’s brand new web community for women: Giving Birth with Confidence.

Uncategorized , , , ,

Understanding Evidence-Based Healthcare: A Foundation for Action

May 20th, 2010 by avatar

Many readers of this blog follow our Understanding Research series developed by our very own Andrea Lythgoe, LCCE. Here’s another learning resource for those interested in deepening their understanding of the fundamentals of evidence-based healthcare.

learningcurve

Consumers United for Evidence-Based Healthcare, a collaborative project of the U.S. Cochrane Center has developed a free online course in six parts that look in-depth with real-world examples about how evidence can be the foundation for action. As the project director, Kay Dickerson, says, “We’re only going to get evidence-based healthcare in this country through consumer activism.”

Lamaze International along with other maternity care advocacy organizations including Childbirth Connection and Our Bodies Ourselves are members of CUE. Here’s an inspiring video about CUE and the importance of consumer involvement in pushing for evidence-based care in the U.S.

Uncategorized ,

Becoming a Critical Reader: Questions to Ask About Qualitative Research

May 17th, 2010 by avatar

Qualitative research generally describes and sometimes explains. It doesn’t try to prove anything. Because qualitative research is more interested in depth, the sample sizes tend to be much smaller. Once you’ve determined that what you have here is an original piece of quantitative research and you’ve already considered the basic questions here and here, you’re ready for the specific questions:

1. Did the researcher have a clear question? Remember in qualitative research, the authors are not trying to prove any hypothesis, but they still should have an idea of what they are setting out to do. It can be as broad as “To explore college students’ beliefs about childbirth and midwifery” or as specific as “to assess certified nurse-midwives’ (CNMs’) knowledge of female Genital Cutting (FGC) and to explore their experiences caring for African immigrant women with a history of genital cutting.”

2. How was the data collected? Was data collection well described?

Among the possible methods are:

Survey – this could be numerical data from a questionnaire or open ended questions with respondents filling out their thoughts and feelings. Sometimes researchers will use an existing tool that has been validated. This means that the survey, test, etc. has been studied and found to consistently give good results. Sometimes there isn’t a validated tool available, so researchers make their own or adapt an existing one. The researcher should describe the tool used.

Interview – Can be done either free-form or with a prepared set of questions/prompts. If a set of prepared questions is used, you’ll often see it (or excerpts) in the published study.

Observation – Can be either overt, where the subjects know they are being observed, or covert, where subjects do not know they are observed. Because being observed sometimes changes behavior, covert observation does have a place. Look for a description of how the observations were recorded. Did the observer make notes? Tally the number of times something happened? Video and audio recordings are sometimes used, but how are they analyzed?

Focus groups – small groups gathered together to discuss issues.

3. What was the setting? The setting is important to the generalizeability of the study. Generalizeability refers to whether or not the study can be applied beyond the scope of the study. Looking at how laboring women communicate with hospital staff probably doesn’t apply to home births, and vice versa. Consider cultural issues as well. While a study on how Hispanic women feel about breastfeeding is valuable, it won’t apply to a Muslim or Eastern orthodox woman.

4. How was the data evaluated/coded? In much of qualitative research, the authors do something called a thematic analysis. This kind of analysis looks for recurring themes. Sometimes the researchers will use coding where they have a list of themes they are looking for and will assign these codes whenever they see them. For example, one study (Ayers, S. (2007) Thoughts and Emotions During Traumatic Birth: A Qualitative Study. BIRTH 34:3 September 2007) listed one possible theme of “Negative Emotions” and assigned that code whenever an interview transcript showed words like “scared” “upset” or “shock”. Look into how the process was done. Was there one person doing the analysis or was it done by different researchers? Did the researcher analyze her own data or have a different person do it? Having multiple people look into the data makes for a stronger study. If the authors describe their analysis using terms you don’t understand, look them up.

5. What is the researcher’s perspective? Is the researcher coming from a medical point of view? A public health point of view? A consumer point of view? Consider how this point of view may have impacted the implementation of the study and the analysis.

6. What was the underlying framework?

Phenomenological – this research framework tries to gain insight into other people’s experience. You’ll often see this framed using the phrase “the lived experience.” Here is an example of a phenomenological study.

Ethnographic Research tries to understand various cultures and social systems. An ethnographic researcher might observe a group of labor and delivery nurses to figure out their social system, or interview student midwives about their interactions with preceptors and each other. Here is an example of an ethnographic study.

Grounded Theory goes beyond simply describing and understanding and actually tries to draw a conclusion that is “grounded” in the data collected. Here is an example of a qualitative study using a grounded theory approach.

There are many other possible approaches, including “integrated” designs which may include aspects of various frameworks.

7. How were the subjects / setting chosen? Often with qualitative research the researchers will use a convenience sample, where they look at a population that they have easy access to, or a quota sample, where they look at the first number of subjects that they can find, up to a set amount. Consider how similar the subject and setting are to your practice. The more similar, the more applicable.

8. And finally, what does this mean for me? That will vary widely based on your personal situation. As a reader, you may be a nurse, midwife, childbirth educator, doula, doctor, or parent. You may have more than one role. Carefully think about how this may – or may not – apply to you in your various roles.

Careful consideration of all these aspects can help you come to conclusions about this study and its usefulness. Next up: Questions specific to quantitative research.

Uncategorized ,

Becoming a Critical Reader: Questions to Ask About Quantitative Research

May 13th, 2010 by avatar

Quantitative research seeks to prove something through experimentation and statistics. Once you’ve determined that what you have here is an original piece of quantitative research and you’ve already considered the basic questions here , you’re ready for the specific questions:

1. How many groups are compared? Did the authors show that the groups are statistically similar? Look for a table showing things like basic demographic information comparing the groups. Some studies will only have one group. In this case, the authors may be comparing the group at two different times (like before and after a treatment) or they may be comparing the study group to the general population using existing data. If the authors are using existing population data as a control, they should demonstrate that the study group is similar to the general population.

2. Did the authors prove correlation or causation? This is a very important distinction to understand.

Correlation just demonstrates that two things tend to happen together. They could be completely unrelated. To use a fictional example, you might find a correlation between mothers with blue eyes and the number of towels used in the labor room, but it does not mean that the blue eyes are the reason for the increased towel use. A correlation can be positive (when the rate of variable A increases, so does the rate of variable B) or negative (when the rate of A increases, the rate of B decreases). You’ll sometimes hear things described as “associated with” – this is generally referring to correlation.

Causation requires statistics and probability to determine if the connection is likely to be because of the variable tested. Researchers must create two groups of participants who are similar in every way except the intervention that they are testing. This can be done by randomizing participants into two groups or using statistical procedures to control for differences.

(This is very much an oversimplification. I’ll be doing a series on statistics later that will explore these concepts further.)

3. Are the tables, charts, and graphs understandable? Do they relate to the conclusions? Could they mislead someone who does not read the text?

4. Is this study population applicable to my practice or situation? Look at the criteria for including (or excluding) the study population. Read it over and see who the study was done with. A study done only with low risk first time moms may not be applicable to a diabetic woman pregnant with her fourth baby. On the flip side, sometimes studies that look at a specific population can provide very useful and helpful information for that specific population. Just make sure you know what the study population is, and recognize that you cannot accurately apply that information to a wider or different group.

5. Are the findings really significant? There is a difference between statistical significance and clinical significance. A student once showed me a study of castor oil induction where the authors reported a significant difference in APGAR scores between the two groups. While the calculated p value was less than .05, the two groups average Apgar scores were 9.78 and 9.71. The babies in BOTH groups had good outcomes – the difference simply didn’t mean much clinically.

6. Is the study size sufficient? In quantitative research, a bigger sample size usually helps. The more you have in the study, you’re better able to find statistical differences. It isn’t just the overall study size, either. Many studies will run analysis of smaller subgroups. So to use another hypothetical example, a study looking at a new drug might have 5,000 women in the study, but if the authors report that “among women who have 6 or more previous pregnancies, the risk is lowered” – you should find out how many women are in that subgroup. If there were only 15 in that subgroup, it might be hard to make a valid conclusion. It is very common to look at subgroups by the number of previous pregnancies, by race, or by other categories.

7. What is being tested, and what is it being compared to? Some studies will have one or more experimental groups and a “control” group as a comparison. This control group will either have no treatment, a placebo treatment, or the current “standard” treatment. Ethically, you cannot test a new cancer drug by giving cancer patients in the control group no treatment, but you can compare a new drug against the current treatment. Make sure that (within the bounds of ethics) the researchers have chosen an appropriate comparison group.

8. What were the outcomes measured? How were they measured? Every study has at least one independent variable – the thing(s) the researchers are trying to learn about. They choose certain things, called outcomes (or dependant variables) to watch for. An example of this would be an epidural study that compares those who have early epidurals with late epidurals. The timing of the epidural would be the independent variable. The outcomes are chosen by the researcher, and could include things like cesarean rate, epidural complications, APGAR scores, etc. The study should clearly outline which outcomes they were interested in and how they were measured.

9. If applicable, did the researchers do a good job of “blinding”? Blinding is the term for keeping from the study participants and staff which group they are in. This is common in drug trials. Sometimes people are helped by simply believing that something will help – the well known “placebo effect”. If the participant does not know which drug they are taking (experimental drug, standard treatment, or “fake” drug with no effects) the researcher can better determine which effects truly are from the drug being tested.  The staff is also blinded whenever possible to avoid accidentally or subconsciously biasing the result. Sometimes blinding is simply not possible, but whenever possible, it is a helpful technique.

10. And finally, what does this mean for me? That will vary widely based on your personal situation. As a reader, you may be a nurse, midwife, childbirth educator, doula, doctor, or parent. You may have more than one role. Carefully think about how this may – or may not – apply to you in your various roles.

Remember that not every study is perfect. Finding a minor flaw in a study does not necessarily invalidate the whole study. You as the reader need to remember to be objective and ask yourself if the study does a good enough job of showing what it set out to do. Because of our differing perspectives and biases, it is possible to come to a different conclusion than another reader. Also, each study should be considered in the context of all the other research done on the topic. Right now that seems overwhelming, doesn’t it? Our next type of article, literature reviews, will give you insight on how you can view studies in the context of other research.

Uncategorized ,