Current resources for evidence-based practice, january/february 2008.

A new Milbank Report focuses on the potential to greatly improve maternity care in the United States through greater fidelity to evidence-based practice. The report, authored by Carol Sakala and Maureen Corry, was developed collaboratively by Childbirth Connection and the Milbank Memorial Fund along with members of the Reforming States Group. Childbirth Connection is a national, notfor-profit organization dedicated to improving the quality of maternity care through research, education, policy, and advocacy. The Reforming States Group is a voluntary coalition of government experts in health policy from all 50 states, with additional members from Australia, Canada, Scotland, and the UK. The Milbank Memorial Fund, founded in 1905, is a national foundation that provides nonpartisan analysis of health policy issues to inform and support the work of private and public health policymakers. The report, entitled Evidence-Based Maternity Care: What It Is and What It Can Achieve, takes stock of the performance of the current maternity care system by considering care processes, maternal and newborn outcomes and value for purchasers. It proposes a framework for evidence-based maternity care based on the principles of ‘‘effective care with least harm’’ to mothers and babies, and reliance on best quality evidence. The proposed framework is applied in an analysis of current maternity care practices in the United States, identifying gaps between evidence and practice. Practices that are overused, under-used, or commonly used despite uncertainty about their effects are called out, and the relationship between evidence about biological childbearing processes and maternity care interventions is discussed. Many systematic reviews that could be used to improve maternity care for large proportions of mothers and babies by limiting overused practices to appropriate circumstances and rectifying underuse of beneficial practices are reviewed. Finally, barriers to wider adoption of evidence-based maternity care are identified, and policy recommendations for greater uptake of evidence are proposed. Electronic copies of Milbank Reports are available without charge from the Fund at www.milbank.org/