Science and midwifery: paradigms and paradoxes

The everyday world of clinical practice is filled with paradigms and paradoxes that stem from the issues of who defines knowledge, how it is generated, and how the individual midwife applies it when providing care for women and families. Research useful for clinical practice should provide evidence to support scientific approaches (models) or strategies (interventions) in caring for women. In a clinical discipline, the answers to research questions should eventually inform clinical decision-making by providing practical clinical knowledge. This article presents an application of Stevenson's research steps for the development of clinically applicable knowledge that the midwife can use to analyze and evaluate research findings as a basis for practice decisions. Specific examples of midwifery research are used to illustrate each stage in the process and the circular nature of knowledge development. The challenge is to prepare midwives who can apply research findings skillfully using the best evidence to support clinical practice, as well as to groom midwife researchers who will develop systematic programs of relevant research about midwifery practice and outcomes.