[Evidence-based midwifery practice in Scotland: a discussion of the problems]

In recent years there has been a drive to base all health care provision upon the most recent, appropriate scientific evidence. This has prompted an interest in research by midwives in clinical practice who want to ensure that they are providing the best possible care. Those midwives who do not use evidenced based practice but instead teach, support and demonstrate ritualistic practices without reference to the substantial research available, are limiting women's choice in maternity care. In a recent trial investigating whether routine suturing of perineal lacerations is required, the trial's outcome was jeopardised because of midwives' beliefs about suturing. The rationale for such ritualistic behaviour is not always easy to understand and using a framework of power and it is examined in this article to determine what concepts are influencing these practices. The article concludes by suggesting that some midwives appear to ignore the results of this trial and other research and demonstrate a paternalistic attitude towards their clients.