Understanding the Key Differences Between Routine Care and Evidence-Based Care

When it comes to maternity care, it’s easy to assume that what is routine is also what’s ‘best.’ After all, if something is standard, surely it must be safe and effective—right? Not always.

Routine care isn’t always harmful, but it also doesn’t necessarily mean “evidence-based.” Some practices may be outdated, unnecessary, or even increase the risk of further interventions. That’s why it’s important for families to understand the difference between routine care and evidence-based care.

Evidence-based maternity care is guided by three important pillars:

• Current research and data

• Clinical expertise

• Your values and preferences
  

This approach creates safer outcomes, minimizes unnecessary interventions, and supports care that is truly individualized and family-centred.

Here are a few common examples where routine doesn’t always equal evidence-based:

1. Continuous Electronic Fetal Monitoring (EFM)

• Routine: In many hospitals, it’s standard practice to keep individuals continuously strapped to monitors.

• What the evidence shows: Research suggests that for low-risk pregnancies, continuous monitoring does not improve outcomes compared to intermittent monitoring. Instead, it can increase the chance of interventions such as cesarean birth.
  

“Childbirth practices should not constitute a one-size-fits-all approach...The indiscriminate use of EFM in the labor room is not improving outcomes, and is actually causing harm to healthy women with uncomplicated pregnancies. Employing a low-tech, high-touch approach needs to be the main philosophy while providing nursing care to most laboring women.” doi: 10.1891/1058-1243.22.3.156. PMID: 24868127; PMCID: PMC4010242.

2. Clamping and cutting cord <1 min after birth

• Routine: In many hospitals, the cord is clamped and cut quickly after birth, often within the first minute.

• What the evidence shows: Delaying cord clamping for at least 1–3 minutes allows the baby to receive extra blood volume rich in iron and stem cells. Evidence shows delayed cord clamping improves newborn outcomes and reduces the risk of anemia
  

“There is growing evidence that delayed cord clamping is beneficial and can improve the infant's iron status for up to 6 months after birth. For the first few minutes after birth, there is still circulation from the placenta to the infant. Waiting to clamp the umbilical cord for 2–3 min, or until cord pulsations cease, allows a physiological transfer of placental blood to the infant (the process referred to as “placental transfusion”), the majority of which occurs within 3 min. This placental transfusion provides sufficient iron reserves for the first 6–8 months of life, preventing or delaying the development of iron deficiency” ncbi.nlm.nih.gov/books/NBK310514/

“Delayed umbilical cord clamping (not earlier than 1 min after birth) is recommended for improved maternal and infant health and nutrition outcomes.” - World Health Organization

3. Supine/laid back pushing position

• Routine: Many people are encouraged to push while lying on their backs, as it is convenient for care providers

• What the evidence shows: Upright positions such as squatting, hands-and-knees, or side-lying are linked with shorter pushing phases, less pain, fewer assisted births, and improved oxygen flow to the baby. Evidence shows that mobility and choice in pushing position can support safer and more effective births.
  

4. Hospital Birth as default option

• Routine: In Canada and many other countries, giving birth in a hospital is the standard and most common practice.

• What the evidence shows: Research shows that for healthy, low-risk pregnancies, planned home birth was associated with lower rates of certain complications and medical interventions than a planned hospital birth:

  • Higher rates of spontaneous vaginal birth

  • Lower rates of caesarean section

  • Lower rates of vacuum or forceps delivery

  • Lower rates of epidural for pain relief

  • Lower rates of postpartum hemorrhage

  • Lower rates of significant perineal trauma

  • Lower rates of episiotomy

  • Lower rates of labour augmentation
    

5. Restricting food and drink

• Routine: Some hospitals still restrict food and drink during labour.

• What the evidence shows: Researchers found that labouring under less restrictive eating and drinking policies led to shorter labours by about 16 minutes and no other differences with regards to Cesareans, forceps/ vacuum use, vomiting, newborn Apgar scores, or any other health issues. One trial found that people permitted to eat had much higher satisfaction with their nourishment during labor (97% vs. 55%)Restrictions on eating and drinking during labor were based on the rare risk of aspiration if general anesthesia was needed. A In a large study of 45 million births, researchers looked at 129 anesthesia and pregnancy-related deaths in the U.S. between 1979 and 1990. During that decade, 33 people died from aspiration during a Cesarean under general anesthesia, or approximately 1 death for every 1.4 million births
  

Why This Matters

Pregnancy and birth are deeply personal experiences. Families deserve care that reflects both the latest evidence and their own preferences, not just “standard practice".

By asking questions like “Is this routine or evidence-based?” and “What are my options?” you become an active participant in your care, helping to create a safer and more positive experience.

Routine care isn’t always wrong, but evidence-based, family-centred care ensures decisions are made with your safety, well-being, and autonomy at the centre.