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About This BookThe full text of the current 3rd edition of A Guide to Effective Care in Pregnancy and Childbirth
(Oxford University Press, 2000) is available on this website courtesy
of the authors: Murray Enkin, Marc J.N.C. Keirse, James Neilson,
Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr. A Guide to Effective Care in Pregnancy and Childbirth is an overview of results of the best available research about effects of specific maternity practices. The book reflects the work of a large international network of researchers, administrators, and consumers. This page provides background information about this book. The book was written for administrators, caregivers, and consumersA Guide to Effective Care in Pregnancy and Childbirth is an essential resource for those who plan, provide, and receive maternity care. The authors have used a clear, concise style to make this information accessible to a broader audience than most medical texts and journals.The Guide continues pathbreaking work that began in the 1970sWork to systematically identify, summarize, and present the best available research about effects of maternity practices began several decades ago following publication of Effectiveness and Efficiency: Random Reflections on Health Services (1972). In this influential book, the British medical researcher Archie Cochrane argued for the general principle of using randomized controlled trial (RCT) research to understand effects of health practices and set policy. He later proposed that every specialty should prepare critical summaries of RCTs in its field and keep them up to date. He argued that, among specialties, obstetrics had been least successful in using research evidence to guide practice.Iain Chalmers — joined over time by Murray Enkin, Marc Keirse, and others — took up this challenge to identify, summarize, and make available results of controlled trials about effects of maternity and newborn care. A chronology identifies some of main steps leading to the development of methodology to prepare systematic reviews of results of controlled trials, and to publication in 1989 of major overviews of the field. Among these overviews was the first edition of A Guide to Effective Care in Pregnancy and Childbirth, in which Enkin, Keirse and Chalmers summarized results of work accomplished to date. The success of this effort led to the decision to extend this work to all areas of health and medicine, and to continue to prepare pregnancy and childbirth systematic reviews and keep them up-to-date under the auspices of the newly formed Cochrane Collaboration (see resources related to A Guide...). The Guide uses the evidence-based framework to clarify effects of practiceIncreasingly, "evidence-based" care and medicine are viewed as desirable and evoked in connection with meetings, publications, and other professional work. Often, the terms are used imprecisely to mean "supported by some research" or as bandwagon slogans without any clear frame of reference.By contrast, authors of the Guide offer a precise definition of evidence-based care with broad international consensus: the "conscientious, judicious, and explicit use of current best evidence in making decisions about the care of individual patients." Their 2nd chapter discusses the "hierarchy of evidence" that guided their work. Where available, systematic reviews summarizing results of the best available research were used to clarify effects of care. In the absence of systematic reviews, they relied upon well-designed randomized controlled trials. Where RCTs were not available, observational research (such as cohort and case-control studies) was used, with the understanding that it offers less definitive conclusions. An acclaimed feature of their book is a final synopsis chapter that assigns hundreds of forms of care to one of six different tables based on the availability, strength, and results of the best evidence about it. Authors of the Guide are evidence-based maternity care leadersThe authors of A Guide to Effective Care in Pregnancy and Childbirth are international leaders in evidence-based maternity care. Two authors — Murray Enkin and Marc J.N.C. Keirse — were centrally involved with the pioneering work to develop the evidence-based approach to health care and apply it to maternity care. The other five — James Neilson, Caroline Crowther, Lelia Duley, Ellen Hodnett and Justus Hofmeyr — are the current editors of the Cochrane Pregnancy and Childbirth Group. All are accomplished in preparing systematic reviews in the field and supporting others in doing so, with the help of extensive resources developed by the Cochrane Collaboration (see resources related to A Guide...).The Guide is now available in an online version to promote broad accessThe authors of A Guide to Effective Care in Pregnancy and Childbirth are committed to making results of this work available to a broad audience. In their agreement with Oxford University Press, they retained the right to an online version of this work, which is now available on this website through a cooperative agreement with the Childbirth Connection.Most recent page update: 3/10/2006
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Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families. |
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New Mothers Speak Out National Report Released The latest report in Childbirth Connection's Listening to Mothers series is now available. Get an eye-opening look at the reality of life as a mother of young children in the United States, based on national surveys conducted by Harris Interactive. Learn more, get the report Read the Wall Street Journal story and listen to the podcast Download Quick Facts (PDF) Why does the national U.S. c-section rate keep going up? Current research points to an optimal cesarean section rate of 5% to 10%, but 1 pregnant woman in 3 is giving birth by major surgery in the United States. Why the surge and is this safe? A new page - and a PDF handout for journalists, policy makers, students and others - answer these questions. Read more about the rising cesarean section rate New Content!
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