Problems of Multidisciplinary Research in Health Care - the Case of Birth Services

Abstract

Much of the medical technology currently in use needs evaluation: it has been introduced without assessment, and indications have changed in practice. However, evaluation of established technology offers methodological and administrative problems which impede it. In addition, social scientists meet with practical difficulties when trying to cooperate closely with doctors These problems are illustrated by our experiences in a project evaluating the structure ot and interventions in Finnish birth care. Our project included assessment of iron prophylaxis, long-term effects of cesarean sections, effect of human support during birth, and use of hospital antenatal clinics. The latter project in particular raised opposition from clinical experts even though increased use of hospital services had caused financial and practical problems. Attempts to prevent our project from taking place came from ethical com mittees and through expert statements; this opposition changed the original study design. These experiences are the basis of a discussion of: the import ance of the object of the research, the definition of research expertise, the myth of personal experience, and the merits of insiders and outsiders as evaluators in medical settings.