Atul Gawande is widely known for his bestselling book called The Checklist Manifesto where he documents the essential role of checklists in ensuring consistency and adherence to evidence based protocols. The Safe Motherhood Community, then, is lucky that his team has turned their attention to safer births in the BetterBirth clinicial trial and collaboration on the WHO Safe Childbirth Checklist.
Malcolm Gladwell reviews The Checklist Manifesto and observes that Gawande "... is really interested in a problem that afflicts virtually every aspect of the modern world–and that is how professionals deal with the increasing complexity of their responsibilities. It has been years since I read a book so powerful and so thought-provoking." If there is any process that is complex and any process that involves responsibility, it is surely the birthing process. The Harvard School of Public Health reports that "The WHO Safe Childbirth Checklist program was developed from 2008 to 2010 through a comprehensive review of existing guidelines and consultation with an extensive network of frontline workers, policymakers, and other health advocates around the globe. It was field tested at 17 birth sites in a number of countries, including India, Pakistan, Nigeria, Kenya, Ghana, and China."
29 key practices comprise the checklist with a focus on bleeding, infection, elevated blood pressure, and prolonged or obstructed labor in mothers and asphyxia, infection, and complications of prematurity in infants. The checklist was studied in Karnataka, India and it was found that adherence to essential practices was increased by 150% after the checklist was introduced. "The results reveal that the number of essential practices performed by the hospital workers increased from an average of 10 of 29 at baseline to 25 of 29 after implementing the checklist" states the Harvard School of Public Health press release.
The next step is to go beyond evaluating changes in staff adherence to protocols and actually document reductions in morbidity and mortality. We'll keep you posted as this study evolves. In the meantime, we are considering