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Evidence-based maternity care uses the best available research on the safety and effectiveness of specific practices to help guide maternity care decisions and to facilitate optimal outcomes in mothers and newborns. Although the field of pregnancy and childbirth pioneered evidence-based practice, resulting in a wealth of clear guidance for evidence-based maternity care, there remains a widespread and continuing underuse of beneficial practices, overuse of harmful or ineffective practices, and uncertainty about effects of inadequately assessed practices.

In order to inform coverage and clinical policy decision making for maternity care, Childbirth Connection (CC), the Reforming States Group (RSG), and the Milbank Memorial Fund (MMF) collaborated to write, review, and publish this report. The report presents a discussion of current maternity care in the U.S. health care system and identifies key indicators that show the need for improvement. The report further summarizes results of the many systematic reviews that could be used to improve maternity care quality, identifies barriers to the use of evidence-based maternity care, and offers policy recommendations and other strategies that could lead to wider implementation of evidenced-based maternity care in the United States. These maternity care quality concerns and opportunities for improvement are not widely recognized at this time.

Organized in 1992, the RSG is a voluntary association of leaders

in health policy in the legislative and executive branches of government, from all fifty states, Canada, England, Scotland, and Australia. The Milbank Memorial Fund is an endowed national foundation, established in 1905, that works with decision makers in the public and private sectors to carry out nonpartisan analysis, study, and research on significant issues in health policy. Established in 1918, Childbirth Connection (formerly Maternity Center Association) is a national not-for-profit voice for the needs and interests of childbearing families. Its mission is to improve the quality of maternity care through research, education, advocacy, and policy.

Many members of the RSG, as well as others knowledgeable in the field, reviewed successive drafts of this report. As a result of these reviews and the authors’ subsequent revisions, we believe that the information in this report is timely and accurate. The matters that have been highlighted by the authors do not necessarily represent the policy preferences of all the members of the RSG or of the other individuals who reviewed drafts of this report.

We thank all who participated in this project.

Eileen Cody

Chair, Health Care and Wellness Committee

Washington House of Representatives

Co-Chair, Reforming States Group

Kevin Concannon

Former Director

Iowa Department of Human Services

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