The challenges of evaluating midwifery continuity of care

Churchill Livingstone Elsevier
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Midwifery Continuity of Care: A practical guide, 2008, 1, pp. 165 - 180
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In this chaprer) we describe some of the challenges associated with evaluating midwifery continuity of care. The notion of 'midwifery care as a complex intervention' is explored as this informs (he way it is evaluated. Midwifery models of care are complex as they consist of a package ofinrerventions. In evaluations we have often tried to reduce the cornplexity, which may actually leave out the things that arc most important. Murray Enkin, one of the original editors of Effective Care in Pregnancy and Childbirth (Chalmers et al. 1989), highlighted this underst·anding by saying "TI,e things that count cannot be counted'. This was a version of a famous quotation by Alben Einstein: 'Everything that can be counted does not necessarily count; and, everything that counts) cannot necessarily be counted'. 'lhis chapter deals with these issues and the importance of maintaining the complexity in evaluations by using a framework developed by the Medical Research Council of the United Kingdom as a way of thinking through and planning an evaluation. 'This chapter also includes a briefcritique of the evidence around midwifery continuity of care presented in Chapter 2.
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