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?
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:
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.
Most recent page update: 4/1/2011
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