Reality is that clinical decisions are necessarily context-dependent.
Nonetheless we need ways to encapsulate the evidence from RCTs and systematic reviews, ways which are useful in making both clinical and policy decisions, and which make the context explicit. The current professional argument is that women with more difficult labours are more likely to have epidurals. The difficult labours are themselves more likely to result in long term back problems. RJ Cook, DL Sackett. N Taub, J O'Dowd, F Reynolds.