This site began in April 2012 as a way for me to document the evidence I found about various birth practices. In June 2012, this site became widely read on an international level. Based on the sheer numbers of people who were reading my articles, I became motivated to increase my standards for evidence-based birth articles.
Importantly, in August 2012, I made a commitment to publish high-quality evidence-based articles that include as little personal bias as possible. In other words, my goal is to present the research evidence and let YOU– the consumers and the clinicians, decide how you want to use the evidence. However, I still make concluding statements that summarize what the evidence supports. If the research points strongly in one direction or another, I will make statements such as, “This evidence shows that this test is preferred over that test,” or “There is not enough evidence to recommend routine use of _____.” However, I try to ensure that these concluding statements are evidence-based and not based on my personal opinion.
In the interest of transparency, here is the process that is followed before each evidence-based article is published. I began using this process formally in August 2012. Articles written before August 2012 used parts of this process, but I did not formalize this process and begin using it consistently until that time.
- A topic is chosen, and I ask myself a series of questions about that topic.
- I take note of my own personal feelings about that topic. This helps me be aware of my biases, which hopefully helps lessen bias during the writing process.
- I conduct a literature review using PubMed, which is the search engine for the National Institutes of Health and the U.S. National Library of Medicine. I choose specific ”key words” that I think will best help me find the articles that I am looking for.
- First, I search for meta-analyses, which are considered the highest level of evidence on a topic. If there are no meta-analyses, I search for randomized, controlled trials. If there are no randomized, controlled trials, then I look at observational studies. If there are no observational studies, then I look at quality control papers or case reports.
- I read through the titles and abstracts (also known as summaries) to determine whether each article is relevant to my search. If an article is relevant, I download the article and read it in its entirety. I read the reference list from each downloaded paper to make sure I did not miss any relevant articles that have been published.
- I add each article that I read into my EndNote file, which is a referencing software.
- Based on the amount of evidence available, I may or may not include time limits in my search. For example, I may limit my search to research studies that have been conducted in the past 10 years. However, sometimes “classic” studies were carried out many years ago and are still relevant today. If I include an older study, I mention in the article if it is considered a “classic” or ground-breaking study.
- I read about the topic using other sources that I have available through my university, including multiple obstetric textbooks (available on MDConsult.com), UpToDate (a subscription service that publishes up to date evidence-based summaries of almost every medical topic imaginable), and practice guidelines from various organizations.
- I begin writing my article, making sure to include a reference for each factual statement that I make. My EndNote software comes in handy here, because it is very easy to insert references and build a bibliography with the EndNote function in Word.
- I add links to each of my references so that readers can look at the research summaries on PubMed.
- Once the evidence-based article is finished, I email it to at least 3 reviewers. One of my reviewers is a non-medical professional whose primary purpose is to make sure that I have eliminated as much bias as possible from the article and that I only present the evidence. The other reviewers are medical doctors (MD) who practice in the obstetrics field and review the content for accuracy as well as bias.
- The reviewers suggest revisions. I make the recommended changes and send it back to the reviewers for a final check.
- The article is published.
- Readers leave comments. If a reader points out that a particular segment of my article is not backed up by evidence, I find the evidence and insert the reference, or I delete/alter that segment. I always welcome comments from readers that help to improve the quality of the articles.