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Evidence-Based Maternity CareWhat 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 struggle to ensure that people receive care that reflects best available research. It is difficult for busy health professionals to keep up with and interpret a large and ever-growing body of studies. Even when they understand lessons from the best available research, it is often hard to give up established beliefs and routines. Many groups have responsibility and a role in ensuring that mothers and babies receive high-quality care. These include clinicians and women themselves, as well as policy makers, payers, administrators, educators, researchers 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, randomized controlled trials (or RCTs) can provide especially trustworthy results. In this type of research, participants are randomized and assigned by chance to receive one or another form of care. Those receiving usual 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 outcomes are due to the treatment under study and not some other difference between the groups.RCTs are not the best design for many important questions. For example, they do not do a good job of measuring less common but important outcomes (e.g., maternal mortality) and outcomes that may occur far into the future (e.g., effects of cesarean surgeries on mothers and babies in future pregnancies). They may be unethical (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, conducted according to established guidelines for research, gives the best possible answers to questions about beneficial and harmful effects 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. Systematic review procedures help limit the bias and error that can easily distort results of single studies and of more conventional reviews of research. They allow us to draw much more accurate and confident conclusions. Fortunately, we now have many thousands of reports of randomized controlled trials and many systematic reviews about effects of specific maternity care practices to help guide care decisions. It is a serious concern, however, that beneficial effects are better studied and recognized than harmful effects. Most recent page update: 10/9/2008
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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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