Evidence-based medicine and perinatal care: from dawn to dusk

Since the concept of "evidence-based medicine" was first launched 20 years ago as a new method of teaching the practice of medicine, it has had an enormous impact on practice in many fields of health care. From the very start, professionals in pregnancy and perinatal care were at the forefront of attempts to collect good evidence systematically on the benefits and harms of health care interventions during pregnancy and in and around childbirth. Perinatal practice has largely benefitted from that endeavor. However, it has also suffered from the ill-effects of the narrow view that evidence, to be good evidence, needs to be randomized evidence. Twenty years on, it may be time to reflect on what is meant by evidence and how to use it, not as a doctrine or dogma, but as a valuable tool and a tremendous asset to improve outcomes for mothers and babies.