Day 18: A Doula's Guide to Understanding Research, part 1

I must admit, I hate math, and following close behind, is interpreting research. Have you ever noticed, many views are given when it comes to "studies" -- often "data" can be found to support opposing views of the same argument. It's enough to avoid a subject entirely, because who knows what to believe? Not feeling confident in one's ability to understand "the facts" as presented by a study can be a real weakness for a doula (and a parent!). Joyce takes this on in two parts, sharing her knowledge of the subject as she offers a primer on how to read, mark, and question a study, to really look at it critically. 

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​My journey to becoming a doula makes plenty of sense in retrospect, but it is a winding journey. I entered college as a pre-veterinary science major, ultimately switched to a Psychology major, hated counseling but fell in love with animal behavior research, and graduated with a BA in Psychology, Biology minor, and Biology Honors. I then entered a PhD program at the University of Nebraska-Lincoln in the Biological Sciences with the intention of becoming a research professor. I actually completed my coursework for a PhD, but cut my research short to graduate with a Masters when I decided a career in academia was no longer what I wanted. After graduation, I became a homemaker and mom when our son was born 5 months later. When he was 10 months old I completed my doula training with DONA International, and attended my first doula birth one month later. Now my husband and I have three children, I am a certified birth doula with DONA International, a Hypnobabies Childbirth Hypno-Doula, co-leader of ICAN of Lincoln (International Cesarean Awareness Network), and have attended more than 55 births. I have a passion for teaching others, empowering women and families to love one another better, birth, birds, and chocolate.

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I wanted to write a guide to other doulas and to parents-to-be on how to find, read, understand, and use primary research literature. There are excellent, free resources where the public can read the full text of research studies, although you may need to ask your physician for papers they can only access using their professional subscriptions. Reading and understanding the scientific literature is a learned skill, and I've given a crash course here. Finally, when you have found, read, and understood the research, using the information will be a highly individual decision that only the patient themselves is able to make, based on their intuition, desires, trusted counsel, and circumstances. Today in Part 1, I address how to find and read research papers, and tomorrow in Part 2, I walk you through a short research article, and discuss how to understand the paper and use the information.
 
How do you find research literature? I won't reinvent the wheel here, Understanding Research and Evidence Based Birth are great places to start. If you find a title that you cannot access without a subscription, sometimes you can search the title on Google Scholar, or even just Google, and find the full text for free. If you only have access to the abstract, use caution. The abstract is the very last piece researchers write before submitting their article for publication, and they may accidentally include incorrect information in their haste. Scientists are human too, remember? So, if you cannot read the whole paper, use caution in using that information to make decisions.
 
Once you've found a paper that interests you, how do you know if it's a good one? The best way is to read it and understand it. The research methods will clue you in to the robustness of the research. The gold standard of medical research is a double-blind randomized controlled trial, in which the individuals receiving the treatments, and those collecting the data, do not know what treatment was received, the treatments are randomly assigned to each individual research subject, and there are appropriate controls against which to compare the treatment effects. However, this is really difficult to do, so it is rare. When you read the methods, do you see any holes in the procedure? Anything that could have an alternate explanation? The fewer alternate explanations of the effects, the better the study. If you have found a review article, or a metastudy, this is gold. These are not primary research articles, but rather they summarize an entire field of research. Metastudies actually take the data from multiple similar studies, group them together and reanalyze the data as if it were one huge study, a powerful method. The Cochrane Database of Systematic Reviews is a great place to find these. While the review may be missing pertinent data, and only includes research conducted prior to submission for publication, these types of papers are wonderful sources of good information, when they exist.
 
Those five years of graduate school were largely devoted to training myself to read and understand the primary literature in my field efficiently. While the average science-literate citizen need not undertake this intense training, a guide to research articles is still necessary, as reading research is not the same as reading other materials. This has been covered well and more extensively by others, so I will summarize my advice here.

• Skip the abstract completely.
• Do write in the margins, underline, write questions. Read it once, and then read it again.
• First read the introduction/background section. Look up any words you don't understand before moving on.
• Identify the author's question, what have they identified is missing in the previous information, and what are they going to investigate? This may be explicit, as an "objective" listed in the article, or you may have to search for it in the text.
• Once you understand the question(s) the authors are investigating, read the methods. Do you think this effectively asks the question the authors want to answer?
• Once you understand what the researchers did, look at the tables, graphs, and charts.
• Once you understand those, read the results section.
• Then read the discussion section. Do you understand the author's conclusions? Do they make sense? Can you think of any alternative hypotheses the authors did not address? Do more questions come up for you?

 
Want more? www.understandingresearch.com, www.sciencebuddies.org, and www.violentmetaphors.com have wonderful guides to reading research articles.
 
Join me again tomorrow for Part 2 where we walk through a short article together and learn what to do with the information once you understand it! This is a short, less than one page, write-up of some preliminary research. Here is the paper:

Afshar, Y; Wang, E; Mei, J; Pisarska, M; and Gregory, K. 279: Higher odds of vaginal deliveries in women who have attended childbirth education class or have a birth plan. American Journal of Obstetrics & Gynecology, 2016;214(1):S162.

Go read it, following my instructions as best you can, and come back tomorrow!

Part 2

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​Joyce Dykema, MSc, CD(DONA), HCHD, became a certified birth doula in May 2012. She is also a trained Hypnobabies® Hypno-Doula, and volunteers as  leadership for ICAN of Lincoln, her local chapter of the International Cesarean Awareness Network. Joyce is a woman-focused doula. While passionate about natural birth and what research shows is the best for moms and for babies, the goal she strives for with every client is for women to have empowering and positive births, as the woman defines it. In addition to her doula credentials, she holds a BA in psychology and an MS in biological sciences. She breastfeeds, uses cloth diapers, uses baby sign language, babywears, and homeschools because these choices made sense for her family; she encourages others to explore and find what makes sense for their families. Joyce and her husband have three children, and live in the Lincoln, Nebraska area.

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