A Values Based Approach to CPG Development

(Approved by AOM Board, November 2006) 

In the development of AOM clinical practice guidelines (CPGs), AOM members value the following: 

REGARDING THE USE OF CPGS 

  1. We value the potential contribution of CPGs to the provision and promotion of high- quality midwifery care.
  2. We value the potential contribution of CPGs to articulate defensible midwifery practice, stating openly what is reasonable midwifery practice.

THE GENERAL PROCESS 

  1. We value a process that is transparent to members.
  2. We value CPGs that reflect all of the values of the AOM including those of informed choice; the client as the primary decision-maker; choice of birthplace; diversity; and appropriate use of technology.

REGARDING SELECTION OF CPGS 

  1. We value a process that encourages the selection of CPGs to include input from practicing midwives.
  2. We value a process that encourages the selection of CPGs to include input from
    the RMP Steering Committee (now called Quality, Insurance and Risk Management Program Steering Committee), which will base its input on actual risk management issues that have come before our insurer, coroner’s cases, and other sources of relevant risk management issues.
  3. We value a process that gives priority to the selection of CPGs around issues and clinical practices that differ from other professions. 

REGARDING CPG CONTENT AND PERSPECTIVE 

  1. We value CPGs that are specific to the midwifery scope of practice as defined by the College of Midwives of Ontario and understand midwifery as a distinct profession and midwives as primary health care providers. 

REGARDING THE CPG DEVELOPMENT PROCESS & CONTENT 

  1. We value a development process that includes input from experienced and expert midwives. 
  2. We value CPGs that reflect the comprehensive and diverse nature of care provided by midwives and the diverse communities in which midwives practice. 
  3. We value a development process that includes evidence-informed research from multiple sources and recognizes that research may be biased or poor and therefore requires critical appraisal and caution when generalizing. 
  4. We value a development process that acknowledges that multiple reasonable interpretations of the evidence is possible. When this is so, these various interpretations will be voiced and CPGs will be based on the interpretation of evidence that will support birth, pregnancy and the postpartum period as a normal physiologic process. 
  5. We value CPGs that acknowledge the necessity of clinical judgment when applied to specific clinical situations. Clinical judgment is the application of evidence in context and it is the integration of clinical expertise, physiologic knowledge, client preferences, clinical findings, the client and family’s goals, values, social context, geographic location, cultural, legal and community factors. 
  6. We value CPGs that value the client’s judgment and choice, recognizing that they may choose differently than a CPG may suggest. 
  7. We value CPGs that are recognize that certain clinical practices may not have any evidence to support them due to lack of research (non- tested practices); this does not necessarily mean that these practices are inappropriate or negative, but only that the research is silent on these clinical practices. CPGs should include these practices and acknowledge where research does not exist to neither support nor refute and should encourage midwifery-based research in these areas. 
  8. We value CPGs that include specific application in the home setting, other out-of- hospital settings, and rural and remote settings. 

REGARDING THE USE OF AOM RESOURCES FOR THE DEVELOPMENT OF CPGS 

  1. If it is possible to honour and uphold all of the above values by conducting a review of an existing guideline, then we would support the use of guideline reviews as part of our process to build a repertoire of clinical practice guidelines. However, if the process cannot honour and uphold all of the above values with a review of existing guidelines, we value the use of AOM resources in the development of in-house guidelines, especially those that focus on midwifery specific activities (e.g. early discharge). When reviews of other guidelines are necessary (e.g. to challenge practice guidelines from a CPG outside of AOM), this may be best accomplished through statement papers rather than through the CPG process. 

OTHER NOTES 

All CPGs should include information to members regarding how to use and how not to use and how not to count on CPGs in all situations, and inform midwives that the CPG should be modi ed to apply to their community, individual cases and should not be prescriptive.