Evidence-Based Maternity Care

What is evidence-based maternity care?

What is the "Gold Standard" for knowledge about the effects of care? Why are randomized controlled trials and systematic reviews valuable resources?

What is evidence-based maternity care?

"Evidence-based maternity care" means using results of the best research about the safety and effectiveness of specific tests, treatments, and other interventions to help guide maternity care decisions.

Health systems should strive to ensure that care that is provided reflects the best available research. Busy health professionals face challenges in keeping up with and interpreting a large and ever-growing body of studies. Even when they understand lessons from the best available research, giving up established beliefs and routines can be difficult.  Many groups have responsibility for ensuring that women and newborns receive high-quality care. In addition to clinicians and women themselves, these include policy makers, insurers, administrators, health professions educators, and journalists.

Some basic principles of evidence-based health care are:
  • Question common assumptions. Be skeptical! Many widely held beliefs about health care do not reflect the best available research. This may lead to poor care and health outcomes. Don't hesitate to say: show me the evidence.
  • Consider the best studies. Quite a few studies are poorly done, and many have weak designs. Poorer quality studies should not be used to guide decisions. When a new study is reported, we should ask: what is already known about this question on the basis of the best available research, and what, if anything, does this study add?
  • Look for the "Gold Standard." When available, well-conducted systematic reviews of research should inform care decisions. If systematic reviews are not available, individual studies with randomized controlled trial designs can provide a good alternative. It may be important to consider other types of studies as well. (See more about systematic reviews and randomized controlled trials below.)
  • Make informed decisions. When making decisions about your care, it is important to consider the best available evidence in combination with your values, preferences and circumstances. Also, take into account care setting issues, such as the skills of caregivers and available forms of care.
 Childbirth Connection and this website
  • use these principles to provide information about the effects of maternity interventions
  • support professionals who want to provide evidence-based maternity care
  • encourage pregnant women to make informed decisions, and
  • encourage women to seek caregivers and care settings with a commitment to evidence-based maternity care.

What is the "Gold Standard" for knowledge about the effects of care? Why are randomized controlled trials and systematic reviews valuable resources?

Among individual studies, a randomized controlled trial (or RCT) can provide especially trustworthy results. In this type of research, participants are randomly assigned to receive one or another form of care. Those receiving the standard care (or placebo treatment such as a sugar pill) are in the control group. Those receiving the type of care that is being studied are in the treatment or experimental group. Random assignment helps ensure that the groups are truly similar, and that any differences in outcome are due to the treatment being studied and not some other difference between the groups. This type of research can also compare effects of different treatments (e.g., drug A versus drug B or one dose versus another).

RCTs are not the best design for some important questions. For example, they do not do a good job of measuring possible differences for rare but important outcomes (such as maternal mortality) and outcomes that may occur far into the future (for example, effects of cesarean surgeries on mothers and babies in future pregnancies). They are not ethical in some situations (for example, we would avoid assigning babies at random to a no breastfeeding group). We need to rely on other types of studies in such cases.

A rigorous systematic review of original studies gives the best possible answers to questions about the benefits and harms of specific health interventions. A systematic review involves a thorough search for the best available studies on a specific topic. If available and appropriate, randomized controlled trial studies are generally preferred. Only relevant and better quality studies are included in the review. When possible, researchers reach a conclusion by combining data from the included studies using statistical techniques called meta-analysis. These techniques help limit the bias and error that can distort the results of non-systematic reviews, thereby allowing us to draw much more accurate and confident conclusions.

Fortunately, many thousands of randomized controlled trials and systematic reviews are available to help guide maternity care decisions. New studies and new or updated systematic reviews are continuously being published in this field. This website helps visitors understand lessons from better quality research and understand questions where more research is needed.

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Informed Decision Making

© 2016 Childbirth Connection. All rights reserved.

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.
Most recent page update: 4/1/2011