Seven tips for finding old copies of guidelines

How can I find old copies of guidelines?

This is a question that I get asked frequently. I am a passionate advocate for ensuring that we share the most up-to-date information with those we care for. But it can be interesting and insightful to be able to discuss changes that have occurred in thinking and evidence. Sometimes, this can be seen by looking directly at the original research in an area. It can also be fascinating to compare different forms of the same document or summary publication.

One example of this kind of publication is NICE guidelines. There have been many instances of guidance changing from one edition to the next. This is understandable, often reasonable and to be expected.

It can sometimes also be controversial; a situation which is inevitable in an arena that is as political as pregnancy and childbirth.

There are also recent examples of the guidance being changed soon after publication.

The VBAC guideline controversy

The guidance for care for women opting for vaginal birth after caesarean (VBAC) is a good example. The updated NICE guideline on Intrapartum care for women with existing medical conditions or obstetric complications and their babies was published in March 2019 and contained new recommendations about electronic fetal monitoring. They were welcomed by midwives and other birth workers who quickly spotted changes made to the recommendations to the care offered to woman seeking a vaginal birth after a previous caesarean.

Notably, the new guideline recommended

Not routinely inserting an intravenous cannula for women in labour (1.19.1)
Explaining to women that there is little evidence of a difference in outcomes for the baby between a vaginal birth or another caesarean section (1.19.3)
Explaining the pros and cons of giving synthetic oxytocin in the first and second stage of labour (1.19.5)
Supporting informed choice of a full range of options for pain relief for women who have had a previous caesarean section, including labour and birth in water (1.19.7).

The guideline also recommended that continuous CTG monitoring should be offered only if the woman is using synthetic oxytocin (1.19.6) or if amniotomy is being performed (1.19.10) and that amniotomy should not be routinely offered to women who have had a previous caesarean section (1.19.9).

These guidelines were in contrast to the 2015 RCOG Green-top guideline on Birth After Previous Caesarean Birth which recommended (among other things) continuous CTG monitoring and intravenous cannulation for all women seeking vaginal birth after caesarean and which made more conservative statements (based on expert opinion rather than the results of research trials) about the outcomes of different approaches.

The full guideline can be read here.

But you won’t find those recommendations in it. That’s because the recommendations were removed just a few weeks later. Instead, the revised edition pointed readers to the guidance in another document.

It’s not hard to imagine why. The two were contradictory. Which illustrates a point I often make: that evidence isn’t absolute. Two people or teams can look at the same evidence and reach different conclusions.

So what you can do if you want to look into such changes? If you want to compare the history of an online document, in a time where people replace the old with the new and leave the web address as is, how can you find the older versions?

My seven top tips

1. Start with a search engine. Many people default to Google, though Google Scholar may be more precise and duckduckgo offers more privacy. Put in the title and date. Try a few search terms. Bear in mind that some search engines take sponsored content, so you may have to hunt. Be willing to read down a few pages and to click back and forth for a while.

2. Try PubMed. PubMed indexes and links more than 30 million citations for biomedical literature from MEDLINE and other sources. It often gives an overview of the original piece, and includes links to the full-text content. Even though something has been updated, the original summary and link will still be in PubMed and it may give you what you need.

3. Check the relevant website for archived documents. Some websites will let you look up the archived versions of their documents. Have a good look around and read carefully. They may also (like The Cochrane Collaboration, for instance) offer a handy summary of the changes that have occurred between one edition and the next. It’s never a bad thing to get to know websites better; you can learn some very interesting things as you go!

4. Phone a friend. If you work for a hospital, university, Trust or other institution, it may be that a consultant midwife or other colleague who has been involved in writing unit guidelines has a copy, either in paper form or archived on their computer. It may also be worth asking lecturer colleagues, especially if they are involved in teaching on this topic. Many of us don’t clean out old folders very frequently.

5. Try the library. This will be easier for those who already have institutional access, but many academic and other libraries have facilities which non-students can sign up to. And some of my favourite people are librarians and they are incredibly knowledgeable.

6. Use internet time travel! The Internet Archive or The Wayback Machine – will let you “travel back in time” to see what a web page looked like at an earlier date. These portals rely on software that trawls the web and captures content at different points in time. The downside is that they can’t capture every page every day. So, as with all of these options, you may or may not find what you need.

7. If all else fails, email and ask nicely. Finally, if nothing else works, the best option may be to email the organisation and ask if they can help you. Do try everything else first. When organisations are inundated with people asking for things that are easily found online, they don’t have time to answer the emails from those who are really at the end of their resources. Be really clear about what you’re asking for, and explain who you are and why you want the document. That may make a difference.

Here’s hoping that helps! If you find my academic tips useful, there are tons more in 101 tips for planning, writing and surviving your dissertation!