Stillbirths and the Oral Tradition of Learning
A colleague shared with me an ABC Radio National site “Why did my baby die”? This went to air January 29th this year. The reporter identified that six stillbirths occur in Australia every year. The key to the interview was the fact that experts have identified that a third of these stillbirths could be prevented but experts believed “fatalistic and outdated attitudes are holding back progress”.
While the stories of the parents who lost their babies were poignant and the interviewed researchers were very good, the thing that really hooked me was the discussions relating to how women who suspected things were wrong were disregarded. The reduction of foetal movement was the main cause of anxiety but their concerns were often triggered by instinct or fears something was wrong.
One researcher reported they heard often that women were not taken seriously. Another finding was that women were “routinely given incorrect advice when they rang up concerned about their baby’s movements”. They were told it was normal late in pregnancy for movements to slow, directed to have a glass of orange juice. This advice the researchers pointed out, was not supported by evidence, it was incorrect and needed to stop.
This section of the interview referred to clinical practice guidelines by the Perinatal Society of Australia and New Zealand. As the interviewer pointed out, these do not recommend eating or drinking something.
Much of the remainder of the program included Dr Jane Warland’s lecture content for midwifery students at the University of South Australia. Her references to the SA perinatal guidelines invited the question of why these were not practiced. Dr Warland’s answer really resonated with me.
“It could be they’re [midwives] are not up to date, can’t be bothered looking, think they know, think it works, it’s what they have always done, very, very hard to change habit. Very, very hard to change what’s in the culture”.
I doubt there is an educator who has never said or thought this while trying to move health professionals to using evidence based practice. That links to another concept, the fact that we nurses and midwives actually rely on oral transmission of information.
What I mean is (myself included) we trust absolutely information transmitted orally and we act on it. As a profession we have been educated and inculcated into the workplace to rely on verbal information. Most of us don’t make time to go and read the policies and protocols if a colleague can give us the information. We don’t take time to search out latest guidelines routinely but are always interested in updates about new procedures or findings that a shared by someone who has read or learned about something.
I wonder if that is why we worry so much about risks and questions about our practice. Does our sense of vulnerability stem from not being able to point with confidence to evidence that directed our actions? I am a proponent of nurses and midwives valuing and using our oral tradition.
Researchers have also supported it. For example Phillips and Haynes, (2008) “Both academics and managers of health services need to embrace the value of workplace conversations, the sites of rich oral traditions of nursing and midwifery”. Other authors for example Beth L. Rogers (2005) while accepting that the oral tradition is essential for nursing knowledge transmission do raise the point that such learning because it lacks structure and is not “scientific” can be seen as non-legitimate learning.
So if we fail to remain current and fail to read and use current evidence-based guidelines and adhere only to habits of practice and colleagues direction, then the issues raised in the ABC interview about how we need to respond to a woman’s concern about her baby’s in utero health will never be implemented. If we do not balance our learned knowledge from colleagues, preceptors and mates with our own research and readings we will not only be failing professionally but risking the health of our clients.
There are some fabulous webinar recordings by Pam Savage regarding Nurses and the Law on the Nurses for Nurses Network . The Nurses for Nurses Network provides good information and CPD on an array of nursing topics in a range of easy learning ways including webinars and quizzes on the latest information that Nurses need to know – remember the Nurses for Nurses Network was created by Australian Nurses for Nurses ! www.nursesfornurses.com.au