Ways of knowing

Midwives are expected to use evidence in their decision making and use knowledge to inform their midwifery practice. In recent years, the term ‘evidence-based practice’ has been used to define the expected level of practice (Spencer and Yuill, 2018). The modern-day concept of evidence-based practice originated in medicine and was heralded by Archie Cochrane in the 1970s (King, 2005). This led to the formation of the Cochrane Collaboration and the rise of midwifery practice that is informed by randomised controlled trials, which were defined as the ‘gold standard’ in evidence (King, 2005).

The original expectation of evidence-based practice was not purely the use of scientific research and although the terms ‘research-based’ and ‘evidence-based’ are not differentiated in the literature, they are different. Sackett et al (1996) define evidence-based practice as ‘the combination of integrating individual clinical experience with the best available external clinical evidence from systematic research’. They define individual clinical experience as ‘the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice’ (Sackett et al, 1996). Sackett et al (1996) also state that there ‘are many types of evidence that can be used as evidence to inform practice’. However, as evidence-based practice originated in medicine, the focus is primarily on using scientific research evidence to inform practice. The patriarchal medical model of maternity care states that obstetricians are the most effective and safest providers of care. In midwifery, accepted practice is based on evidence. However, is this the knowledge that midwives use to make decisions?