gms | German Medical Science

Despite the widespread availability of high quality research evidence to inform the care of childbearing women, there continue to be large gaps between evidence and practice. As a result, women are not receiving optimum care, they are being subjected to interventions which put them and their babies at unnecessary risk, and the unnecessary interventions are costly for health care systems struggling to meet the needs of the entire population.

Decades of knowledge translation studies which evaluate strategies to increase the adoption of forms of evidence-based care have met with disappointing results. In addition, the strategies are costly and time-consuming. I will describe the results of Cochrane Reviews and other relevant studies, to illustrate the challenges, failures, and successes of a wide variety of interventions to increase the use of evidence-based forms of intrapartum care.

Twelve characteristics of hospitals which have low intrapartum intervention rates illustrate the important of organizational, social, and environmental factors on care. An exciting area for future research involves simple but radical changes to hospital labour rooms. New approaches are needed, which recognize that intrapartum care is influenced by the setting within which care is provided, as well as the attitudes, beliefs and behaviors of caregivers and care recipients.

Research in behavioral economics has demonstrated the value of “nudging.” Nudges change the way choices are presented in an environment. Three tenets of effective nudging are: 1) to encourage an activity, make it easy, 2) one cannot implement evidence-based policy without evidence, and 3) it is important document your results and share them widely. I will offer examples to illustrate how care givers have used nudging effectively, in promoting desirable forms of care.

Financing: The research studies in which I was involved were funded by the Canadian Institutes of Health Research, the (US) National Institutes of Health, Heather M. Reisman Chair in Perinatal Nursing Research funds, the Ontario Women’s Health Council, and the (Canadian) National Health Research and Development Program. The Cochrane Reviews which I led had no external funding sources.