Midwifery clinical guidelines valuable to all maternity care providers

This summer, the Association of Ontario Midwives (AOM) released its newest clinical practice guideline, Hypertensive Disorders of Pregnancy. The guideline is available in various formats, making the information even more accessible for midwives, pregnant women and other health care providers.

The guideline provides a critical review of research questions relating to midwifery care and the screening, diagnosis, assessment and monitoring of hypertensive disorders of pregnancy, including preexisting hypertension, gestational hypertension and preeclampsia and makes recommendations for standards of care related to high blood pressure issues during pregnancy.

Midwives are registered health professionals who provide primary care to women with low-risk pregnancies throughout pregnancy, labour and birth and to both mother and baby for the first six weeks after birth. “Because the way in which midwives practice differs from that of other care providers, having their own guidelines that take those differences into account is valuable,” explains Tracy Franklin, practicing midwife and guideline contributor.

“We practice informed choice with clients, so we need to be familiar with the research, the standards and the guidelines in order to present that information to our clients,” Franklin says. “But we also take into account individual women and their situations and other personal factors that are important to them. We want to provide informed choice that includes all of the information and research women need to make that choice.”

Developed by practicing midwives who perform extensive literature searches and evaluate the latest and most valuable research, AOM guidelines reflect women-centered maternity care and use the best available evidence to promote normal birth.

AOM guideline authors also investigate whether there is research to support alternative therapies that clients ask about. The new hypertension guideline, for example, evaluated whether calcium or vitamin C and E supplementation help reduce the risk of preeclampsia and found there was no evidence to support vitamin C or E supplementation but that women who are at risk of developing preeclampsia and/or had low calcium intake would benefit from increased calcium either through diet or supplementation.

One valuable addition that was made to this latest midwifery guideline was a six-page summary that provides midwives with easy access to the most essential content. Franklin says that because hypertension is such a complicated issue and the 64-page guideline is so exhaustive, the summary is a great tool for those already familiar with the guideline but who need quick, “on the spot” reference.

Tasha MacDonald, director of the AOM’s clinical practice guideline program, says the plan is to include similar summaries with future guidelines.

MacDonald says the summary is not only valuable for health care providers, but a useful tool in discussing informed choice with clients. “The guideline summary makes the research accessible to clients who are interested in knowing more about midwifery best practice for a specific clinical topic,” she says.

In an effort to give midwives access to this information on the go and at their fingertips, the AOM is also currently developing an app based on the hypertension guideline that is expected to be available in the fall. The app would be accessible to all care providers via mobile devices.

Though other care providers have their own guidelines that support their scope of practice, Franklin says midwifery guidelines can be valuable beyond standard midwifery practice. “I think it would help other care providers understand the complexity of negotiating midwifery care,” she says, adding that clinicians would likely take comfort in the amount of research and thoughtful writing included within the guideline. Midwives make reference to other familiar research guidelines such as the National Institute for Health and Clinical Excellence guidelines and Society of Obstetrician and Gynaecologist guidelines.

The guidelines could also be of great use to others who provide maternity care to low-risk women, such as family doctors, nurse practitioners or midwives working outside of Ontario.

The Hypertensive Disorders in Pregnancy guideline,  one of 11 clinical practice guidelines available from the AOM, which cover issues such as group B streptococcus, prelabour rupture of membranes and vaginal birth after caesarean section.

The guidelines are available on the AOM website at http://bit.ly/aomcpgs