Evidence-based care means looking at the meta-studies, which analyze the outcomes and design of multiple studies on an issue, and using the conclusions to determine the best ways of providing health care.  Evidence-based care in birth is not practiced in US hospitals.  Promoting continous labor support; avoding induction for suspected big baby; avoiding routine (i.e. done for no specific reason) continuous electronic fetal monitoring; allowing food, drink and movement in labor — none of these evidence-based interventions are common in the labor and delivery ward of most local hospitals.  When I hear opponents of health care reform talk about the scourage of "rationing" medical care, I get so frustrated, because I know that, at least in the childbirth arena, if we only paid for interventions when they were evidence-based, (that is, if we rationed useless intervention), we would have better outcomes.  Many fewer women would begin motherhood recovering from major abdominal surgery.  Many fewer babies would be born late preterm because a mom was told that the ultrasound machine knew better than her body when her baby should be born.  And midwifery care would be covered and promoted by any health care plan, because the best, cheapest, and most satisfying outcomes for healthy women happen outside the hospital under the care of midwives.