Each year, about 130 million births occur, but over 5 million of these result in the mother’s death, stillbirth, or newborn death within 28 days. Even more concerning is the fact that an overwhelming majority of these occur in resource-poor settings and are preventable. As a result, the WHO developed the Safe Birth Checklistas a response to these problems (the Checklist was originally developed by Atul Gawande, the physician champion of the role of checklists in medical care).
The checklist itself is simple but addresses a variety of problems that can occur during childbirth, such as main causes of maternal death, stillbirths, and neonatal deaths. It’s made up of 31 items divided into four parts for use during different stages of the birthing process:
1) On admission
2) Just before pushing or c-section
3) within 1 hour of birth, and
4) before discharge
During development, the list followed rigorous methodology and was tested for usability in ten countries across Africa and Asia.
The BetterBirth studyhas been going on since 2012 in over 100 hospitals in Uttar Pradesh, India, to test whether the Safe Birth Checklist really results in better health outcomes for mothers and babies.
In 2015, a paper was published detailing the process and outcomes of adapting the checklist in a randomized controlled trial in Uttar Pradesh. Results from phase I of the study found that despite positive reactions from clinic staff , lack of resources and motivation prevented significant improvements in performance of life-saving birth practices.
In response, changes were made in phase II. The intervention now included a formal engagement approach and motivational strategy that involved meeting with the district chief medical officer who gave information on the goals and procedures of BetterBirth programs. Phase II saw much more encouraging improvements in many critical areas, including screening for pregnancy-associated complications, infection control, oxytocin immediately after delivery, and postpartum care of newborns. Immediate administration of oxytocin, for example increased from 36 percent to an impressive 97 percent.
The processes through which the Safe Childbirth checklistis administered need to be continuously revised and refined to make sure that they work for different communities. A 2015 study in Sri Lanka, for example, showed that despite staff training the Checklist was used in only 45 percent of the 1800 births over the study period.
Many studies have found that the checklist is effective in encouraging behaviors that result in healthier mother, babies, and communities in some of the most vulnerable places in the world. In Namibia, success at one major facility, Gobabis Hospital, where the maternal mortality rate was reduced after one year to ZERO, has resulted in a nationwide rollout of the BetterBirth Checklist. We will 'check in' on this scale up in a future blog. Be sure to consider the Checklist for quality improvement at your facility.
Blog by Vivian Shih & Meg Wirth
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