This news story appeared in Essentially MIDIRS, August 2014, vol 5, no 7, page 16
Midwifery practice, like all mainstream medicine in the UK, is based on evidence. Official bodies such as the Royal College of Obstetricians and Gynaecologists (RCOG) examine the evidence and publish recommendations and guidelines, based on the best evidence, to enable health care professionals in their decision-making. At least that is how evidence-based medicine has been generally understood, but new research has come to light that throws this into question.
An analysis of the evidence base underlying 52 of RCOG’s Green-top Guidelines by Prusover et al (2014) suggests that only 9-12% were based on the best quality evidence. A descriptive study of 1682 individual recommendations found that, from December 2007 onwards (when the RCOG changed its classification of evidence system), ‘114 (9%) were based on level A evidence; 145(12%) level B; 210 (17%) level C; 276 (22%) level D and 502 (40%) were recommended best practice (Figure 1b). This suggests that, contrary to the aims of evidence-based medicine, guidelines published more recently are actually more likely to be based on clinical experience alone’ (2014:3).
Whilst Green-top Guidelines do make overt their evidence gradings and declare them alongside resulting recommendations, it is remarkable how much is based on experience rather than evidence, and therefore open to bias. The UK is not alone in this:
‘…a study by Wright in 2011 found that only one-third of the recommendations by the American College of Obstetricians and Gynecologists were based on good scientific evidence (Wright et al. 2011). In similar studies, this was the case in 14% of the recommendations by the Infectious Diseases Society of America (Lee and Vielemeyer 2011), and 45% of cardiovascular risk recommendations from guidelines across the USA, Canada and Europe (McAlister et al. 2007)…’ (2014:1).
This certainly provides food for thought.
Prusova K, Churcher L, Tyler A et al (2014). Royal College of Obstetricians and Gynaecologists guidelines: how evidence-based are they? Journal of Obstetrics and Gynaecology. 12 June [Online ahead of print].