Action teams will be established to bring together members around specific research priorities to develop research questions, design studies and establish project teams, with the support of members of the research panel.
Once a topic has been identified as a priority by members of the BC Midwifery Network, members will be invited to submit an expression of interest using the EoI form. This will ask members to outline briefly how they will be involved and the contribution that they will make to the action team.
Members can be involved in action teams in different ways, depending on their expertise and interest in the topic and their experience to date. For example, they may want to lead an action team, contribute to the design of the study, review the literature, be involved in instrument design, data collection or analysis, or writing, or it may be their first real involvement with research and they may want to get a sense of what it is like to work in a research team. They may also want to be involved because of their interest in or knowledge of the topic, or their expertise in working with particular issues or challenges. The aim of the action team model is to bring together an appropriate mix of clinical and research expertise and learners, all of whom will work together to grow the research idea and learn together through the process.
Oral Probiotic Supplementation in Pregnancy and its Impact on Reducing Infant Exposure to Antibiotics at Birth
It is estimated that about 30% of pregnant women are colonized with Group B Streptococcus (GBS) and GBS is a leading cause of neonatal morbidity and mortality. Current practice is to screen all pregnant women at 35-37 weeks gestation and to routinely administer intravenous prophylactic antibiotics (IPA) to women who test positive for GBS. This practice has significantly reduced the rate of infection of infants but IPA itself is associated with antibiotic resistance, allergic reaction and reduced mobility in the woman. It has also been shown to interfere with the establishment of the gut flora in the infant and the development of neonatal immunity, and is associated longer-term with chronic conditions such as asthma, diabetes, and obesity. Probiotics are live microorganisms that can be ingested to improve a woman’s intestinal microbial balance, preventing the establishment of pathogens such as GBS in the gut and vagina. Preliminary research suggests the administration of probiotic supplements to women in pregnancy may reduce the incidence of GBS at term, thus reducing the need to IPA to women during labour. This double-blinded randomised control trial will examine if oral administration of specific probiotics to pregnant women from 25 weeks gestation will reduce the incidence of GBS at term, compared to women who take a placebo. Following extensive review of the research and consultation with researchers in the field, three probiotic strains that are currently available in over-the-counter products have been selected for the intervention. Recruitment to the study will begin in March 2017 and up to 600 women attending midwives, family doctors and obstetricians in the Vancouver and the Lower Mainland will be recruited to the study.
Dr. Michelle Butler, PhD
Water Birth Outcomes Study
Immersion in water has been used for many years as a comfort measure in labour. Over the past few decades, the popularity of giving birth in water has increased.
Much research has attempted to investigate the risks and benefits of the practice to both mother and infant. However, many studies examining the outcomes of water birth have been poorly designed, have lacked power or had inadequate controls. The studies are variable and there considerable heterogeneity in reported outcomes. Furthermore, Canadian data on water birth outcomes is severely lacking. There is currently no strong evidence of any of the purported benefits to water birth. The suggested maternal benefits remain unclear and no peer-reviewed study purports to prove any benefit to newborn. Despite this, current randomized controlled trials are also insufficient to detect significant differences in neonatal negative outcomes.
Given that women continue to request water birth, we need better evidence to answer questions such as what knowledge and understanding should clients have regarding water birth, who are appropriate candidates for water birth, what are the risks to the mother, what are the risks to the baby, and what type of informed risk and benefit should be discussed.
The current study aims to report on the audit data collected submitted to the department.
1. To document the outcome of midwifery attended water births
2. To determine if there are any differences in water birth outcomes versus a matched cohort of midwife-attended land births.
Dr. Zoë Hodgson, PhD
A Pilot Study to Examine Outcomes Associated with the Use of the "Labour Cocktail"
Many midwives in British Columbia discuss the option of a “labour cocktail” to initiate labour with clients requesting a non-medical method of labour induction. Castor oil, a potent cathartic, and Verbena Officinalis, are common ingredients in such cocktails. However, their role in the initiation of labour is poorly understood and sparse data into their efficacy exist. This results in midwives basing their informed choice discussions with clients on anecdotal reports alone.
Evidence for the use of the cocktail is based on small numbers, varied cocktail ingredients / protocols for use, diverse research methodologies, and dichotomies in reported outcomes. Further, no Canadian data on the use of the labour cocktail has been published despite the anecdotal report of its widespread use. With induction of labour being one of the most common obstetrical interventions, with preliminary data indicating that 23.2% of labours will be induced in 2015/16 (PSBC 2016), there is a need for the examination of the efficacy and safety of alternative methods.
A recent discussion over the BC Midwives email network uncovered much interest and enthusiasm in gathering Canadian data related to the use of the labour cocktail. Furthermore, it became apparent that a few midwifery clinics had been collecting such data over recent years.
1. The current pilot study aims to collate the existing data, describe and analyse perinatal outcomes associated with the use of the labour cocktail;
2. The analysis will be used to discuss the design of a prospective BC wide study of:
a) The prevalence of the use of the labour cocktail amongst midwives in BC
b) The ingredients, dose of cocktail recipes, and protocol for its use
c) The circumstances under which, and characteristics of the population to whom, the cocktail is offered and used
d) Perinatal outcomes associated with ingestion of the labour cocktail.
Dr. Zoë Hodgson, PhD
The Use of Poke Root as an Alternative Remedy in the Treatment of Mastitis
The prevalence of mastitis in breastfeeding women may be as high as 33%. Effective milk removal, pain medication and antibiotic therapy have been the mainstays of current treatment. The College of Midwives of British Columbia (CMBC) lists antibiotics for the treatment of symptoms consistent with mastitis for more than 24 hours, or sooner in the context of worsening pain. However, due to the overuse of antibiotics, the issue of antibiotic resistance is fast growing.
There is evidence that the use of Complementary and Alternative Medicine by childbearing women is becoming increasingly popular in Canada. Despite this, there is limited research evidence regarding the use of alternative therapies in the treatment of lactational mastitis.
The current study will explore the use and effectiveness of Poke Root in the treatment of lactational mastitis in BC midwifery clinics. Poke Root is a herb that can, anecdotally, be effective in clearing mastitis. However, a literature search revealed no published studies of its application nor effectiveness in the case of lactational mastitis.
The proposed study has three main objectives:
1) To document the use of Poke root as a treatment for mastitis in BC
2) To gather data on the effectiveness of poke root in treating mastitis
3) To ascertain care provider satisfaction with poke root as a treatment for mastitis
Dr. Zoë Hodgson, PhD
Perinatal Mental Health
Holistic care is defined as physical, psychological, social and spiritual care (James & Field, 1992). Midwifery care is considered a holistic care. According to the International Confederation of Midwives (ICM)’s philosophy of Care (2014), “midwifery care is holistic and continuous in nature, grounded in an understanding of the social, emotional, cultural, spiritual, psychological and physical experiences of women”.
In a literature review of midwives attitudes and practice pattern, we found that midwives have very positive attitudes towards addressing mental health needs of women during perinatal period. However they may not necessarily feel competent or adequately trained to offer mental health care to women.
Perinatal mental health problems such as depression and anxiety are very common. One in five women may experience depression/anxiety during pregnancy or postpartum period. Despite its significance and prevalence, maternal mental health problems remain under-diagnosed and under-treated conditions in practice.
Majority of women with poor perinatal mental health do not actively seek help.
In practice, only one fifth of parental care providers screen for perinatal mental health symptoms and a very small fraction of women receive mental health services.
Unclear pathways after screening and accessibility of services may also impact health care providers attitudes towards mental health screening and management.
The purpose of this action team is to bring together midwives and other individuals with passion for mental health needs of pregnant and postpartum women to develop research questions, design studies, conduct research, and implement findings.
Dr. Hamideh Bayrampour, PhD
Pilot Study into Midwifery Supervision Models for British Columbia
Based on the findings of research of midwives in BC by Jane Wines, this project will explore the implementation of a model of supervision for midwives.
It was shown that midwives in BC need, and want, a stronger support system. They are sometimes asked by clients to continue providing care, even when it is outside of community norms. Sometimes that care would also be outside of scope of care. At present, they may be able to provide that care within their community, but often they feel obliged to discharge the client from care, find a midwife in another community, or some midwives have even recommended care from an unregistered midwife. Midwives have also ‘played the system’. They have provided the care the client has asked for, but doing so ‘under the radar’, a method of provision that may put both the midwife and client at risk.
Midwives often want to provide care to the client, either because they see the requests as safe, they feel strongly about supporting informed choice, or that their care may be a method of risk reduction. Those midwives that do so may face, or fear facing, retribution from the hospital, from their midwifery colleagues, or from their regulatory body.
Midwives sometimes just need support, either through education and access to resources, or with extra hands at a birth. They may need witness to their discussions, or a midwifery second opinion.
Many midwives can access this support from their community. However a significant number are either isolated geographically, isolated from their midwifery and/or medical colleagues, face conflict in their hospitals, or have fear for their safety as practitioners.
Supervision is a system used in several jurisdictions which provides support for midwives in all of these situations. Supervisors are peer nominated, trusted and separate from any regulatory or employment body. Supervisors are not in positions such as department heads, nor do they sit on committees that may have influence in a midwives ability to get privileges etc.. They are not involved in disciplinary processes.
I would like to build a team that would
1. Research models of supervision, and create a model that might best suit the needs of BC Midwives.
2. Draft a proposal for a pilot project, and seek support and funding for the project.
3. Implementation and evaluation of the pilot.
Jane Wines, RM, MSc