Research blues

I realized yesterday, while attending my first research class, that I have done my first homework assignment for that class completely wrong. I thought we were supposed to come up with a topic that we wanted to research, i.e. do a literature review of all of the relevant articles out there, and see what’s currently being investigated about said topic. So, I blithely picked a topic that interested me, and thought I was good to go. Wrong. What we’re really supposed to do is come up with an idea for original research, and begin to draft a research proposal for said idea. This semester involves picking the problem we want to tackle, and doing the background research necessary to see what’s out there. Next semester will involve designing the study itself, and then writing it up into a proposal. Since we’re at the Master’s level and not the doctorate level, we won’t actually have to carry out the research, but by the time we’re finished, we should have a nice fat proposal that we could potentially send out for grants and sponsorship. It all sounds a bit daunting.

The topic I wanted to research was the 24 hour deadline held over women’s heads like a guillotine once their membranes have ruptured: deliver or else. The reason given for this 24 hour rule is that supposedly the inicidence of chorioamnionitis (an infection of the placenta and membranes) increases drastically after 24 hours, especially if the woman is Group Beta strep positive, and this infection can be dangerous for both the mother and baby. I have never looked at the hard numbers on this, though. I wonder what the rate of infection is, and if it really merits such a sharp deadline. I have seen many deliveries where the woman is still asymptomatic at 24 hours, afebrile and not showing any signs of infection, but her doctor urges a c-section on her anyway instead of allowing her to continue to labor. I wonder if the research really backs up such decision making. My instinct is that the clock ticks much more impatiently on women with ruptured membranes, and that this urgency and impatience, which is then used to justify inductions, augmentations and cesareans, is not actually necessary. I have no idea if this suspician is true, though. That’s what I wanted to investigate.

However, investigating this is just a simple matter of doing a literature review. It’s not a research design or proposal, and I can’t for the life of me think of a research study I could perform that could measure this, or contribute in a meaningful way to the literature. Doing a randomized control trial is not really an option. This doesn’t have much to do with midwifery, anyway. It’s more of a hard science, obstetrical connundrum, and I would rather do something more midwifery related.

So, back to the drawing board. Any suggestions on research proposals? It will require a lot more thinking.

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2 Comments

  1. Posted September 16, 2005 at 4:38 pm | Permalink

    So in the context of a Midwifery program, what kind of original research are you expected to do? Do they expect you to get data by interviewing people, or doing lab experiments, or compiling and interpreting statistics, or…

    Since there ARE places where the 24-hour deadline is not enforced and women are allowed to labor longer (the Farm in Tennessee, at the very least) it seems like you might be able to get enough comparative data to do some original analysis on this issue.

    Since I’m a social sciences girl, my head goes to interviewing mothers and midwives about their experiences. Has anyone in “the literature” so far documented the effects on women of feeling rushed by this deadline? It’s one thing to look at the problems identified, interventions and birth outcomes (“failure to progress” leading to caesarean, etc) and entirely another thing to actually get the story, in which the woman is “failing to progress” because she is scared and being told by the “experts” that her body is not working fast enough.

    Or… what alternatives exist that can reduce the risk of these infections while allowing women to labor longer? Who is out there trying them? (You don’t have to limit yourself to the U.S., here, either.) What outcomes are they finding? How would you design a study to test the effectiveness of one of these alternatives in the hospital where you work, or a local birthing center?

    I realize I could be totally barking up the wrong tree here, since I don’t know what they want from you. But it seems like there could be stuff to work with on this topic. Have you talked with any classmates about what they’re researching?

  2. The Student
    Posted September 18, 2005 at 8:32 pm | Permalink

    Becca: These are all *great* suggestions. I especially like the idea of interviewing women to see how the 24-hour-deadline affects them. I bet that the pressure of the deadline works against them, if it doesn’t actually shut their labor down altogether. I have noticed that whenever a woman gets too much in her “head”, and out of her body, her labor tends to slow down or completely stop, and there’s nothing like an arbitrary, unflexible deadline and all of the inherent anxiety that it brings with it, to drag a woman out of her body and back into her head.

    This seems to be a much more qualitative and anthropological approach, though, which is fine, but not something I’m that familiar with. But that’s okay, because hey, what’s the point of being a student if you don’t force yourself to learn new things?

    I have a meeting with my professor this week to discuss my options. I’ll certainly keep everyone posted about what we come up with, but you’ve set the little wheels spinning. Thank you!

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