Barriers to optimal and appropriate use of uterotonics during active labour and for prevention of postpartum haemorrhage in public health care facilities: An exploratory study in five states of India

Abstract

ObjectiveThe main objective is to understand the practices regarding use of uterotonics during active labour and for prevention of postpartum haemorrhage and the barriers for its optimal and appropriate use at different levels of health facilities in five states of India. Study DesignMixed methods approach comprising of cross-sectional observational study of existing practices of uterotonics use during labour and early postpartum period for 1479 vaginal deliveries at 56 facilities. Quantitative data was collected using pre-tested proformas filled by on-site observers and qualitative data was collected by in-depth interviews of 125 maternity care providers of the observed facilities. Main outcome measureProviders’ knowledge, attitude and patterns of use of uterotonics during active labour and for prevention of postpartum haemorrhage during childbirth. ResultsOn-site observation and interviews indicated inappropriate choice of uterotonics administered in varied doses for labour management across facilities. Unnecessary augmentation of labour was observed in 44.7% low-risk pregnancies and only 31% women were administered uterotonics in optimal doses for preventing postpartum haemorrhage. Only 46.4% providers in the observed facilities reported to have received maternal and child healthcare training according to the updated guidelines. Lack of supportive supervision for mandated practices among peers emerged as an important barrier for appropriate uterotonics usage in labour. ConclusionThere is an urgent scope of standardizing the institutional health policies regarding administration of uterotonics during labour and for prevention of postpartum haemorrhage. Capacity building of maternity care providers regarding appropriate uterotonics usage is recommended for all levels of health facilities.