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A gap between evidence and practice in managing normal labour is common in many countries.
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Practice change is often influenced by opinion leaders.
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What this study adds
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In some hospitals in Shanghai there is a substantive gap between best practice derived from reliable evidence and actual practice.
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Over four years (1999–2003), obstetric practice in these hospitals became more evidence-informed, with substantive changes in some routine procedures.
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Change towards evidence-informed practice was mainly influenced by the hospital director; change away from evidence-based practice was the result of legislation about medical accidents.
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Regional seminars about best practice seemed to have had little direct influence on change.
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