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Glob Health Sci Pract. 2017 Jun 27;5(2):217-231. doi: 10.9745/GHSP-D-16-00410. Print 2017 Jun 27.

Improving Adherence to Essential Birth Practices Using the WHO Safe Childbirth Checklist With Peer Coaching: Experience From 60 Public Health Facilities in Uttar Pradesh, India.

Author information

1
Ariadne Labs, a Joint Center between Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA.
2
Population Services International, Lucknow, Uttar Pradesh, India.
3
London School of Hygiene & Tropical Medicine, London, UK.
4
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
5
Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
6
Community Empowerment Lab, Lucknow, Uttar Pradesh, India.
7
Jawaharlal Nehru Medical College, Karnataka, India.
8
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
9
Department of Medicine, Harvard Medical School, Boston, MA, USA.
10
Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
11
Population Services International, Washington, DC, USA. rfirestone@post.harvard.edu.

Abstract

BACKGROUND:

Adherence to evidence-based essential birth practices is critical for improving health outcomes for mothers and newborns. The WHO Safe Childbirth Checklist (SCC) incorporates these practices, which occur during 4 critical pause points: on admission, before pushing (or cesarean delivery), soon after birth, and before discharge. A peer-coaching strategy to support consistent use of the SCC may be an effective approach to increase birth attendants' adherence to these practices.

METHODS:

We assessed data from 60 public health facilities in Uttar Pradesh, India, that received an 8-month staggered coaching intervention from December 2014 to September 2016 as part of the BetterBirth Trial, which is studying effectiveness of an SCC-centered intervention on maternal and neonatal harm. Nurse coaches recorded birth attendants' adherence to 39 essential birth practices. Practice adherence was calculated for each intervention month. After 2 months of coaching, a subsample of 15 facilities was selected for independent observation when the coach was not present. We compared adherence to the 18 practices recorded by both coaches and independent observers.

RESULTS:

Coaches observed birth attendants' behavior during 5,971 deliveries. By the final month of the intervention, 35 of 39 essential birth practices had achieved >90% adherence in the presence of a coach, compared with only 7 of 39 practices during the first month. Key behaviors with the greatest improvement included explanation of danger signs, temperature measurement, assessment of fetal heart sounds, initiation of skin-to-skin contact, and breastfeeding. Without a coach present, birth attendants' average adherence to practices and checklist use was 24 percentage points lower than when a coach was present (range: -1% to 62%).

CONCLUSION:

Implementation of the WHO Safe Childbirth Checklist with coaching improved uptake of and adherence to essential birth practices. Coordination and communication among facility staff, as well as behaviors with an immediate, tangible benefit, showed the greatest improvement. Difficult-to-perform behaviors and those with delayed or theoretical benefits were less likely to be sustained without a coach present. Coaching may be an important component in implementing the Safe Childbirth Checklist at scale.Note: At the time of publication of this article, the results of evaluation of the impact of the BetterBirth intervention were pending publication in another journal. After the impact findings have been published, we will update this article on the effect of the intervention on birth practices with a reference to the impact findings.

PMID:
28655800
PMCID:
PMC5487085
DOI:
10.9745/GHSP-D-16-00410
[Indexed for MEDLINE]
Free PMC Article

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