Abstract
Shifting childbirth into facilities has not improved health outcomes for mothers and newborns as significantly as hoped. Improving the quality and safety of care provided during facility-based childbirth requires helping providers to adhere to essential birth practices-evidence-based behaviors that reduce harm to and save lives of mothers and newborns. To achieve this goal, we developed the BetterBirth Program, which we tested in a matched-pair, cluster-randomized controlled trial in Uttar Pradesh, India. The goal of this intervention was to improve adoption and sustained use of the World Health Organization Safe Childbirth Checklist (SCC), an organized collection of 28 essential birth practices that are known to improve the quality of facility-based childbirth care. Here, we describe the BetterBirth Program in detail, including its 4 main features: implementation tools, an implementation strategy of coaching, an implementation pathway (Engage-Launch-Support), and a sustainability plan. This coaching-based implementation of the SCC motivates and empowers care providers to identify, understand, and resolve the barriers they face in using the SCC with the resources already available. We describe important lessons learned from our experience with the BetterBirth Program as it was tested in the BetterBirth Trial. For example, the emphasis on relationship building and respect led to trust between coaches and birth attendants and helped influence change. In addition, the cloud-based data collection and feedback system proved a valuable asset in the coaching process. More research on coaching-based interventions is required to refine our understanding of what works best to improve quality and safety of care in various settings.Note: At the time of publication of this article, the results of evaluation of the impact of the BetterBirth Program were pending publication in another journal. After the impact findings have been published, we will update this article with a reference to the impact findings.
Highlights
The reduction of preventable maternal and neonatal morbidity and mortality associated with childbirth remains a critical challenge in global health.[1,2]BetterBirth Program: Coaching-Based Implementation of the World Health Organization (WHO) Safe Childbirth Checklist www.ghspjournal.orgPreviously, countries—especially low- and middle-income countries—have embraced interventions focused on encouraging childbirth to take place in health care facilities; despite the success of many of these interventions, the shift to facility-based childbirth has not succeeded in improving all childbirth-related outcomes at the levels expected.[3]
We describe important lessons learned from our experience with the BetterBirth Program as it was tested in the BetterBirth Trial
The BetterBirth Program was centered around coaching in an effort to encourage the consistent, effective delivery of essential birth practices through adoption and use of the Safe Childbirth Checklist (SCC), and to sustain this change through individual and facility- or team-level empowerment
Summary
The reduction of preventable maternal and neonatal morbidity and mortality associated with childbirth remains a critical challenge in global health.[1,2]BetterBirth Program: Coaching-Based Implementation of the WHO Safe Childbirth Checklist www.ghspjournal.orgPreviously, countries—especially low- and middle-income countries—have embraced interventions focused on encouraging childbirth to take place in health care facilities; despite the success of many of these interventions, the shift to facility-based childbirth has not succeeded in improving all childbirth-related outcomes at the levels expected.[3]. The reduction of preventable maternal and neonatal morbidity and mortality associated with childbirth remains a critical challenge in global health.[1,2]. One important component of high-quality health care is the provision of care according to evidence-based guidelines. In facility-based childbirth care, one of the main causes of preventable harm is the failure to deliver essential birth practices to all mothers and newborns at the appropriate time during childbirth. Essential birth practices are provider behaviors for which evidence exists to prove that they increase the quality and safety of care during childbirth; these practices, when performed consistently and correctly, can save the lives of mothers and newborns. The failure to perform these practices is often called a “know-do” gap and has been identified in many areas of health care.[4]
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