Sharing our findings to improve outcomes

Dr Adele Macgregor was awarded the 2024 John Ritchie Prize for her presentation ‘Determining effect of ethnicity and parity on utilisation of obstetric epidural: a retrospective audit’ submitted for the Aotearoa NZ Anaesthesia ASM.

Adele shares what motivated this research, leading her first research project from conception to completion as a trainee, and why research is so important to her practice.

What influenced your choice of topic for this study?

We wanted to find evidence to determine whether Christchurch was providing an equitable service for all wāhine. Our clinical observations and conversations between practitioners led us to believe there may be differences in who has access to epidurals. We wanted to initiate that discussion and ensure that the way care is delivered in Christchurch does not create barriers to accessing epidurals for any patient.

I also noticed huge variations in what education patients have received about pain relief options during their pregnancies. In the epidural consent process, the first question I like to ask a birthing parent is how much they have learned about labour analgesia options throughout their pregnancies. Clearly, it’s not ideal to provide that education while they are in labour. However, there is considerable variation in the information our birthing parents are getting.

What inspires you to get involved in research?

The central role it has in improving patient outcomes is what drives me. We can hypothesise and make all the assumptions we want in our day-to-day clinical practice, but without research to back those hypotheses, it’s really hard to make changes and improve outcomes. Especially for our vulnerable populations.

Although I don’t have a natural aptitude for research, I see it as central to my clinical practice. Learning how to do these studies well and in a culturally sensitive way is one of the most important things I can do to improve outcomes for my patients.

Has your research influenced your practice?

This study has significantly influenced my daily practice by ensuring I reflect on myself and my biases. Particularly when we engage in conversations or handover about individuals—their background and experiences during their antenatal journey may affect their current experience. For women, especially younger women, pregnancy and birth are often the first time they spend considerable time in our health system as patients. Having a positive experience where they are treated fairly and listened to can influence their future interactions and those of their children moving forward.

Why did you submit your abstract for this study to the 2024 Aotearoa NZ Anaesthesia ASM?

I believe it’s important for us to share our research findings with our population of practitioners, otherwise, what’s the point in doing the research? Not sharing our findings can exacerbate inequities. We’ve found inequity and if we want to see change, we should all be considering if our practice could be contributing to this. Hopefully this might lead to more research in the area, educational resources for Māori and Pacific peoples or more conversations.

As a junior researcher, it also helps me develop more of an understanding of what good research looks like. Not doing research well can also lead to worsening equity and I want to do the best I can for the populations I’m asking questions of.

How do you juggle your research and training commitments?

It has been challenging at times. Setting realistic expectations has been important and approaching it in bite-sized chunks has helped. I’ve utilised time between my primary and final exams to do this latest project.

I’ve been involved in two other research studies, but this is the first I’ve taken from conception to completion. Where I’ve designed and led the project myself with lots of help. I’ve had a great team who’ve been patient with me and not put too many timelines on things, which helped. I’ve also had an incredible statistician, which I am grateful for, I would never be able to achieve the quality of results myself. It’s important to find the right people and we’ve got some really supportive people in Christchurch who have been great at letting me borrow their time.

Any tips for other trainees considering research or their required audit for training?

Finding a project you’re passionate about and are experiencing during your day-to- day clinical practice makes it easier to form hypotheses and develop ideas. As well as focusing on something you want to learn more about, and an area where you want to make improvements. This has really driven me. I have a little previous experience in investigating Māori health, but through the results of this study I’ve learnt a lot more about our Pacific populations. It has led me to discuss the results with Pacific health workers in Christchurch to learn about what might have contributed to our findings, which has been valuable in informing my own clinical practice.

You’re moving to the next phase of the project, do you have an outlook of what you hope to achieve by the end of this next stage?

The results of our study showed the difference isn’t as large as we expected, for multiple reasons, which is good. What we didn’t expect is that there is a big difference between Pacific peoples but not so much with Māori.

The next step is to have a discussion with women birthing in both primary and birthing centres, to ensure that they have had enough information antenatally to feel as though they could make an informed choice about their labour analgesia options.

The main thing I’d like to learn is what access women in Christchurch have to antenatal education. To get a good understanding from those who want antenatal analgesia information, what information is out there, where people are accessing it, if they know where to find it and how robust it is. To understand the barriers and if the information they’re being given is balanced and evidence-based.

We want to ensure that their preferences and needs are respected and prioritised. We, as practitioners, should not let our own bias influence the care they receive, and we want to ensure that there are no systemic barriers preventing a patient’s preferences for labour analgesia from being central to the care they receive.