title: "The midwifery two-step": a study on evidence-based midwifery practice.
abstract: BACKGROUND
  To date, there has been little documentation of how practice-based midwifery networks in the United States might influence the transfer and development of knowledge in childbearing and women's health care. The first phase of this participatory action research project was to conduct a qualitative study with a community of midwifery practices to understand their perspectives on evidence-based practice and how an organized network could facilitate their work.
  
  
  METHODS
  Midwives within the community of interest were invited by letter or e-mail to participate in individual or small group interviews about knowledge transfer, primary concerns of evidence-based practice, and potential for a midwifery practice-based research network. Participatory action research strategies and organizational ethnographic approaches to data collection were used to guide qualitative interviews.
  
  
  RESULTS
  Eight midwifery practices enrolled in the study with 23 midwives participating in interviews. They attended births at 2 hospitals in the community. Two broad areas of discourse about evidence-based practice were identified: 1) challenges from influential persons, finances and resources, and the cultural perception of midwifery, and 2) strategies to foster best practice in the face of those challenges. The midwives believed a research network could be useful in learning collectively about their practices and in the support of their work.
  
  
  CONCLUSIONS
  Evidence-based practice is a goal but also has many challenges in everyday implementation. Practice-based research networks hold promise to support clinicians to examine the evidence and form strong coalitions to foster best clinical practice. The second phase of this study will work with this community of midwives to explore collective strategies to examine and improve practice.
authors: Yale University School of Nursing, New Haven, CT 06536, USA. holly.kennedy@yale.edu
authors: Holly Powell
authors: HP
authors: Kennedy
authors: Eleanor
authors: E
authors: Doig
authors: Barbara
authors: B
authors: Hackley
authors: Mayri Sagady
authors: MS
authors: Leslie
authors: Stephanie
authors: S
authors: Tillman
mesh_terms: D019058:Community Networks; D003299:Cooperative Behavior; D055318:Evidence-Based Nursing; D006302:Health Services Research; D006801:Humans; D007400:Interprofessional Relations; D008880:Midwifery / Q000458:organization & administration / Q000592:standards*; D015403:Nursing Evaluation Research / Q000458:organization & administration* / Q000592:standards*; D011785:Quality Assurance, Health Care; D014481:United States