Differences in evidence-based care in midwifery practice and education

Purpose: To examine site-specific differences in managing labor and to describe variations in intrapartum practice in the context of clinical midwifery education. Design: Descriptive design based on secondary analysis of an existing data set collected to evaluate the intrapartum clinical experiences of nurse-midwifery students. The data set included 498 records collected by midwifery students in 23 sites from 1995-1998. The unit of analysis was the intrapartum record. Methods: Students used The American College of Nurse-Midwives Clinical Data Set for Intrapartum Care to collect data during clinical experiences, including patient demographic data, risk factors, and specific care processes and interventions. Findings: Significant variations were found among settings despite use of the same clinical guidelines. Discrepancies between theoretical preparation of students for clinical practice and the realities of clinical practice were noted. Conclusions: Despite a stated commitment to evidence-based practice, practice patterns varied significantly. Clinicians and educators need to find common ground for combining evidence-based theory with evidence-based practice.