From Scurvy to Social Media: Why Evidence-Based Maternity Care Takes a Village (and a Century)

Soraya Malik in Health & Wellness June 2025 • 6 min read.

"Unpacking the Slow and Speedy Paths of Medical Evidence into Everyday Practice: Lessons for Modern Healthcare"

One of the biggest hurdles in healthcare is figuring out which research to act on and how quickly to turn it into routine practice. It's often said that it takes about 17 years for solid evidence to become the norm in clinical settings. This seems especially true in maternity care. What's really interesting is that some findings are embraced almost immediately, while others take decades to catch on. These are translation ‘hares’ and ‘tortoises.'

The recent ARRIVE trial is an example of research getting fast-tracked into practice, even with lingering questions. This pattern of slow and fast adoption has been around for ages. Take scurvy: back in 1749, James Lind, a Royal Navy surgeon, did a study showing citrus fruits could treat it. He published his findings in 1753, but it was mostly ignored. People thought scurvy was due to rotting, not a lack of vitamin C. Yet, Captain Cook made sure to carry citrus fruits on his first voyage in 1768, though it wasn't standard practice. It wasn't until 1795 that the Admiralty made lemon juice a routine provision, and the early 1800s before it was fully implemented. That's sixty years to get evidence into practice—definitely a tortoise pace.

A more recent example is using corticosteroids for women at risk of preterm birth. The initial studies in sheep in New Zealand in the late 1960s led to the first human RCT in 1972, followed by a systematic review in 1990. By the 2000s, a single dose of corticosteroids for women at less than 32 weeks gestation at risk of giving birth was common in many high-income countries, however, coverage remains low in low- and middle-income countries.

When Evidence Races: The Swift Adoption of Some Practices

Hare and Tortoise Race: A visual metaphor for the speed of evidence-based practice adoption in maternity care.

Some practice changes occur almost overnight. A prime example is the impact of the Term Breech Trial on vaginal breech births. Many remember exactly where they were when the trial results came out in 2000 and how the next day, practice drastically changed. Clinicians quickly accepted the findings of one RCT without hesitation. Despite critiques in academic circles, it made little difference. Subsequent research suggests that vaginal breech births can be safe under the right conditions. The 'hare' had truly taken off.

Slowing down has taken more than a decade. The tide is shifting, and many health services in Australia have dedicated breech clinics and midwives and doctors who are willing to enable women to have a vaginal breech birth. There are also government policies in some Australia states supporting women who want a vaginal breech birth. It is a slow process though and women in many high income countries have little to few options.

Immediate Acceptance: Findings that align with existing beliefs are quickly integrated.
Fear Factor: Evidence supporting potential risks is swiftly translated into practice.
Complexity: Complex interventions often face slower adoption rates.

Midwifery continuity of care—a complex intervention with strong evidence—is another tortoise. Despite initial RCT evidence from Caroline Flint in 1989 and subsequent studies and government reports, access remains low in countries like Australia. Surveys show that only a small percentage of women receive this type of care, despite consistent demand. Despite all this, in countries like Australia, the proportion of women having access to midwifery continuity of care remains low. One Australian study has estimated that only one third of 149 maternity managers who were surveyed reported that their hospital midwifery continuity of care, and an estimated eight percent of women received this type care at the time of the survey, most of whom were considered to be of 'low obstetric risk. On social media, in blogs and other media, women consistently report wanting midwifery continuity of care, our students and new graduates say they want to work in this way but it remains a tortoise in many places.

Making Change Happen: A Call to Action

Our journal publishes the evidence but it is in the hands of our readers to make change happen in an effective timeframe. We need to plan implementation as early as possible in our research and use principles and designs from the discipline of Implementation Science to bring about change. I challenge you, as the readers of Women and Birth and practitioners in maternity care, to find the 'tipping point' where evidence-based practice is translated and transferred into common practice in maternity care. We need to make sure the high level evidence is embedded in practice in a timely manner, and more importantly, we need to stop doing things that are shown to be not based on evidence. This is a worthy challenge for us that will improve outcomes for mothers and babies in all our settings.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.wombi.2018.10.006, Alternate LINK

Title: Getting Evidence Into Practice – Managing Hares And Tortoises

Subject: Maternity and Midwifery

Journal: Women and Birth

Publisher: Elsevier BV

Authors: Caroline Homer

Published: 2018-12-01

Everything You Need To Know

What are 'hares' and 'tortoises' in the context of maternity care, and why is it important to understand them?

In maternity care, 'hares' refer to medical research findings that are rapidly adopted into practice, while 'tortoises' are those that take many years to become standard. Understanding this difference is crucial because it highlights the varying speeds at which evidence-based practices are implemented, impacting patient outcomes and the overall quality of care. Recognizing these patterns helps identify barriers to adoption and promotes strategies for more timely integration of beneficial practices, ultimately improving outcomes for mothers and babies.

Can you provide an example of a 'tortoise' in maternity care mentioned and explain why its adoption was slow?

An example of a 'tortoise' is the adoption of lemon juice as a routine provision to prevent scurvy. Although James Lind demonstrated the effectiveness of citrus fruits in treating scurvy in 1753, it wasn't until 1795 that the Admiralty made lemon juice a routine provision, and the early 1800s before it was fully implemented. This slow adoption was due to prevailing beliefs that scurvy was caused by rotting, rather than a lack of vitamin C, illustrating how entrenched misconceptions can hinder the acceptance of evidence-based practices.

What factors contribute to the swift adoption of certain medical practices, creating 'hares' in maternity care?

Several factors contribute to the swift adoption of medical practices. Practices are more likely to be rapidly integrated if they align with existing beliefs, address immediate and visible threats (fear factor), or are relatively simple to implement. The Term Breech Trial, which influenced a rapid shift away from vaginal breech births, exemplifies this, as clinicians swiftly accepted the findings of one RCT without hesitation.

What is 'midwifery continuity of care,' and why is it considered a 'tortoise' in terms of implementation, especially in countries like Australia?

'Midwifery continuity of care' refers to a model where women receive consistent care from the same midwife or a small team of midwives throughout their pregnancy, childbirth, and postpartum period. Despite evidence supporting its benefits, its implementation has been slow, making it a 'tortoise.' In countries like Australia, access remains low due to factors such as organizational barriers, resistance to changing established practices, and challenges in scaling up the model to meet demand, despite consistent demand by women.

Why is it important for readers of journals like 'Women and Birth' and practitioners in maternity care to understand implementation science, and how can it improve the adoption of evidence-based practices?

It is crucial for readers of journals like 'Women and Birth' and practitioners in maternity care to understand implementation science, because it provides frameworks and strategies to effectively translate research evidence into routine clinical practice. By planning implementation early in the research process and using implementation science principles and designs, practitioners can identify barriers to adoption, tailor interventions to specific contexts, and facilitate the widespread and timely integration of evidence-based practices, ultimately improving outcomes for mothers and babies.