The Cochrane Database is probably the most important reference for maternity health care providers. It was comprised by a group of researchers who, over a period of ten years, hooked up -- by Medline -- to most of the major libraries in the world, did a hand-search of over 60 key journals from 1950 issues onward. They wrote to 40,000 obstetricians and pediatricians in 18 countries in an attempt to identify unpublished studies. They presented in a systematic synthesis of all this data, using methods to reduce bias and random error, two major works: one called Effective Care in Pregnancy and Childbirth, a 1,500 page book in two volumes; and the other, a regularly updated electronic database of review. The latter is now incorporated in the Cochrane Database of Systematic Reviews and is available on disk as Cochrane Pregnancy and Childbirth Database. To make it more available to both providers and those receiving the care of providers, A Guide to Effective Care in Pregnancy and Childbirth was published in 1989, a handy pocketbook edition. Now in its third edition, this text forms the basis for evidenced-based practice for both providers and those receiving the care of providers in pregnancy and childbirth.
The process for evaluating the research allows a range of conclusions. The information is divided up into categories ranging from beneficial forms of care, forms of care likely to be beneficial, forms of care with a tradeoff between beneficial and adverse effects, care of unknown effectiveness, care unlikely to be beneficial and care likely to be ineffective or harmful.
It is interesting that many of the routine procedures practiced in labor and birth have not been beneficial to mothers and, therefore, have been eliminated by many providers and hospitals. This includes things such as routine enemas, routine pubic shaves, routine episiotomy, even routine electronic fetal monitoring for women who do not have complications of pregnancy and birth. The significance of this monumental research effort is to provide the evidence we need for our practice, for the procedures and the type of care we are giving to women in pregnancy and childbirth. The evidence supports what the birth centers have been attempting to do. It supports the woman's choice for the place of birth.
The woman should choose the place where she is most comfortable. It supports the midwife/obstetrician team with the midwife as the primary care provider and the obstetrician as the care provider for the mother with problems. These two factors alone support anyone's effort to either use a birth center or to establish a birth center in their community.