WHO Safe Childbirth Checklist Research Articles

Implementing the WHO Safe Childbirth Checklist: lessons learnt on a quality improvement initiative to improve mother and newborn care at Gobabis District Hospital, Namibia

Background Although there are many evidence-based practices that reduce the risk of maternal and neonatal mortality around the time of birth, there remains a gap between what is known and...

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.

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. 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. 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%). 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.

The BetterBirth Program: Pursuing Effective Adoption and Sustained Use of the WHO Safe Childbirth Checklist Through Coaching-Based Implementation in Uttar Pradesh, India.

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.

Implementation of an adapted Safe Childbirth Checklist in rural Chiapas, Mexico: an evaluation study

Abstract Background The Mexican Ministry of Health has advocated for increased skilled birth attendance in hospital facilities to decrease maternal and newborn morbidity and mortality. Partners In Health (PIH) works in a rural region of Mexico where the home birth rate is 60%. The primary purpose of this project is to improve the quality of care, including adherence to evidence-based practices and promotion of respectful practices during childbirth, in a rural hospital in Chiapas, Mexico. Additionally, we hope to strengthen the role of professional midwives and obstetric nurses as competent clinicians in managing women with low-risk pregnancies during childbirth. Methods PIH collaborated with Ariadne Labs to adapt and implement the WHO Safe Childbirth Checklist in a rural hospital in Angel Albino Corzo, Chiapas. Four pause points (at admission, just before delivery, within 1h of birth, and before discharge) were adapted according to the local context. Additional items were added to capture respectful practices during childbirth. We provided coaching training to the professional midwife and perinatal and obstetric nurses to make optimal use of the checklist for ongoing quality improvement in a team-based environment. The checklist and coaching tools have been developed into a mobile application using CommCare for instant data capture and continuous monitoring and evaluation. We used a mixed-methods study to capture adherence to evidence-based practices and integrated these findings with patient and provider experiences during labour and delivery. We conducted post-discharge surveys and post-partum interviews to explore how patients perceive the care they received during childbirth. Findings By August, 2016, five obstetric nurses, one perinatal nurse, and one professional midwife were using the adapted Safe Childbirth Checklist in the study hospital. Data collection using CommCare began in September, 2016, and will continue until June, 2017. By March, 2017, we had captured data from about 350 birthing women using the WHO Safe Childbirth Checklist and 160 women who had completed the discharge survey. We have conducted interviews with 25 postpartum women and some of their birth companions. Data collection is ongoing but preliminary data from September to December, 2016, show that 64% (171/266) of women were asked at least two questions about their preferences in labour, 13% (28/216) of women received episiotomies without indication, 68% (147/216) initiated skin-to-skin within 1h of delivery, and 56% (122/216) of women initiated breastfeeding after delivery. Preliminary analysis of the discharge surveys reveal high satisfaction with the care women received at the hospital. Qualitative interviews indicate some variation in birth experiences. Interpretation There is some variation in adherence with evidence-based practices and perceptions of good quality of care at the rural hospital since implementing the adapted Safe Childbirth Checklist along with other PIH-driven community initiatives. While we do not have a baseline for these indicators, our intervention represents the first attempt at any quality improvement initiative for childbirth care in this region, and adoption will require continued buy-in from hospital staff. Funding The MacArthur Foundation, and Brigham and Women's Hospital Division of Women's Health.

Effectiveness of the WHO SCC on improving adherence to essential practices during childbirth, in resource constrained settings.

BackgroundIndia accounts for 27 % of world’s neonatal deaths. Although more Indian women deliver in facilities currently than a decade ago, early neonatal mortality has not declined, likely because of insufficient quality of care. The WHO Safe Childbirth Checklist (SCC) was developed to support health workers to perform essential practices known to reduce preventable maternal and new-born deaths around the time of childbirth. Despite promising early research many outstanding questions remain about effectiveness of the SCC in low-resource settings.MethodsIn collaboration with the Ministry of Health SCC was modified for Indian context and introduced in 101 intervention facilities in Rajasthan, India and 99 facilities served as comparison to study if it reduces mortality. This Quasi experimental Observational intervention-comparison was embedded in this larger program to test whether a program for introduction of SCC with simple implementation package was associated with increased adherence to 28 evidence-based practices. This study was conducted in 8 intervention and 8 comparison sites. Program interventions to promote appropriate use of the SCC included orienting providers to the checklist, modest modifications of the SCC to promote provider uptake and accountability, ensuring availability of essential supplies, and providing supportive supervision for helping providers in using the SCC.ResultsThe SCC was used by providers in 86 % of 240 deliveries observed in the eight intervention facilities. Providers in the intervention group significantly adhered to practices included in the SCC than providers in the comparison group controlling for baseline scores and confounders. Women delivering in the intervention facilities received on an average 11.5 more of the 28 practices included compared with women in the comparison facilities. For selected practices provider performance in the intervention group increased as much as 93 % than comparison sites.ConclusionUse of the SCC and provider performance of best practices increased in intervention facilities reflecting improvement in quality of facility childbirth care for women and new-born in low resource settings.

ISQUA16-3132EFFECTIVENESS OF THREE INTERVENTION PROGRAMS DESIGNED TO IMPLEMENT WHO SAFE CHILDBIRTH CHECKLIST IN COLOMBIA

To evaluate the effectiveness of three different strategies for training in the use of WHO Safe Childbirth Checklist (SCC) in Colombia health institutions to improve neonatal and maternal patient safety. Quasi-experimental before and after study. Three training programs were designed and implemented in three facilities for implementing of the use of WHO SCC. Random assignation to the intervention was performed. The safety behaviors were assessed in the four moments of the attention (on admission, just before pushing or caesarean, soon after birth and before discharge) on 29 births per institution, and the acceptance of the checklists was assessed in 38 workers of the institution A, 74 of the institution B and 50 of …

Implementation of the WHO safe childbirth checklist program at a tertiary care setting in Sri Lanka: a developing country experience.

BackgroundTo study institutionalization of the World Health Organization’s Safe Childbirth Checklist (SCC) in a tertiary care center in Sri Lanka.MethodA hospital-based, prospective observational study was conducted in the De Soysa Hospital for Women, Colombo, Sri Lanka. Healthcare workers were educated regarding the SCC, which was to be used for each woman admitted to the labor room during the study period. A qualitatively pretested, self-administered questionnaire was given to all nursing and midwifery staff to assess knowledge and attitudes towards the checklist. Each item of the SCC was reviewed for adherence.ResultsA total of 824 births in which the checklist used were studied. There were a total of births 1800 during the period, giving an adoption rate of 45.8%. Out of the 170 health workers in the hospital (nurses, midwives and nurse midwives) 98 answered the questionnaire (response rate = 57.6%). The average number of childbirth practices checked in the checklist was 21 out of 29 (95% CI 20.2, 21.3). Educating the mother to seek help during labor, after delivery and after discharge from hospital, seeking an assistant during labor, early breast-feeding, maternal HIV infection and discussing contraceptive options were checked least often. The mean level of knowledge on the checklist among health workers was 60.1% (95% CI 57.2, 63.1). Attitudes for acceptance of using the checklist were satisfactory. Average adherence to checklist practices was 71.3%. Sixty eight (69.4%) agreed that the Checklist stimulates inter-personal communication and teamwork. Increased workload, poor enthusiasm of health workers towards new additions to their routine schedule and level of user-friendliness of Checklist were limitations to its greater use.ConclusionsAmongst users, the attitude towards the checklist was satisfactory. Adoption rate amongst all workers was 45.8% and knowledge regarding the checklist was 60.1%. These two factors are probably linked. Therefore prior to introducing it to a facility awareness about the value and correct use of the SCC needs to be increased, while giving attention to satisfactory staffing levels.

Safety and Quality of Maternal and Neonatal Pathway: A Pilot Study on the Childbirth Checklist in 9 Italian Hospitals

Maternal and neonatal mortality and morbidity associated with childbirth is a global health problem of the highest priority. Of the more than 130 million births each year, the WHO estimates that about 287.000 are maternal deaths, 1 million fetal deaths during intra-partum period and 3 million deaths of infants during the neonatal period. In low- and middle-income countries, low levels of quality and safety of care still represent an important “issue”. The presence of protocols, procedures and cognitive support tools represent still key factors along with procedure for integration with the territory, continuity of care at birth path. In high-income countries the use of tools to support the work of health workers with the aim of managing clinical risk and improving patient safety, is quite usual. The pilot study aims to design and to test a safety checklist for supporting sharp-end healthcare workers coping with critical activities during delivery. The pilot study is based on quantitative analyses to evaluate the tool in terms of usability, feasibility and impact on team working, communication among member's team and work organization. The evaluation process related to the pilot allowed the researchers to collect very interesting input from the clinicians aimed at improving the tool in terms of usability and patient safety. Implications for the theory are the redesign of some areas of the checklist according to the specific organization of a delivery center. The pilot study also allowed the researcher to engage clinicians thanks to their direct involvement in designing the best solution that can fit their daily work. The checklist, as most of the checklists in healthcare settings, promotes the interdisciplinary work, as the control process has to be done by different figures. This is still a big challenge. Implication for practice is the extension of the pilot at the regional level with the involvement of 3 teaching hospitals and the analysis of more than 3000 cases. The results of the extended pilot will constitute the basis for the participation to the WHO Safe Childbirth Checklist program.

Efficacy of Evidence Based Care on Care Quality of Mother and Infant in 3 Teaching Hospitals: A Protocol

Introduction: Reducing infant mortality rate during delivery is a priority in the world. Even with the existing activities that take place in hospitals, due to a lack of simple and effective methods, this mortality reduction trend is slow. The objects of this study were to apply and investigate the effects of WHO evidence-based guidelines for safe delivery on the quality of maternal and neonatal support. Materials and Methods: This is a semi-experimental study with external control. After forward and backward translation of WHO safe childbirth checklist, in an expert meeting irrelevant/infeasible items in the checklist were omitted or modified. Personnel performance on checklist items was evaluated by researchers who were present in the whole period of mother and neonate hospitalization in two phases. Intervention was done in two hospitals and one hospital was considered as control. At first, the instructions were provided for all the collaborating personnel in forms of pamphlets, posters and booklets and after two weeks second phase began by arranging an educational session for personnel. The data of these two phases is being compared. Discussion: If our prior assumption be proved, we anticipate improvements in some items of checklist .Some of these items are skin contact, breast feeding rate in first hour postpartum, hand hygiene, and mother's knowledge regarding the parturition during the time in which they are hospitalized together with a decrease in episiotomy infection/dehiscence prevalence. These changes can be regarded as an overall promotion in maternal/neonatal support.

Designing the WHO Safe Childbirth Checklist program to improve quality of care at childbirth

BackgroundPoor-quality care during institutional births in low- and middle-income countries is a major contributing factor to preventable maternal and newborn harm, but progress has been slow in identifying effective methods to address these deficiencies at scale. Based on the success of checklist programs in other disciplines, WHO led the design and field testing of the WHO Safe Childbirth Checklist—a 29-item tool that targets the major causes of maternal and newborn mortality globally. MethodsThe development process consisted of comprehensive evidence and guideline review, in-person consultation with content experts and other key stakeholders, iterative refinement through ongoing discussions with a wide collaborator network, and field evaluation for usability in 9 countries, primarily in Africa and Asia. Pilot testing in South India demonstrated major improvement in health workers’ delivery of essential safety practices after introduction of the program. ResultsWHO has launched a global effort to support further evaluation of the program in a range of contexts, and a randomized trial is underway in North India to measure the effectiveness of the program in reducing severe maternal, fetal, and newborn harm. ConclusionA novel checklist program has been developed to support health workers in low-resource settings to prevent avoidable childbirth-related deaths.

Improving Quality of Care for Maternal and Newborn Health: Prospective Pilot Study of the WHO Safe Childbirth Checklist Program

BackgroundMost maternal deaths, intrapartum-related stillbirths, and newborn deaths in low income countries are preventable but simple, effective methods for improving safety in institutional births have not been devised. Checklist-based interventions aid management of complex or neglected tasks and have been shown to reduce harm in healthcare. We hypothesized that implementation of the WHO Safe Childbirth Checklist program, a novel childbirth safety program for institutional births incorporating a 29-item checklist, would increase delivery of essential childbirth practices linked with improved maternal and perinatal health outcomes.Methods and FindingsA pilot, pre-post-intervention study was conducted in a sub-district level birth center in Karnataka, India between July and December 2010. We prospectively observed health workers that attended to women and newborns during 499 consecutively enrolled birth events and compared these with observed practices during 795 consecutively enrolled birth events after the introduction of the WHO Safe Childbirth Checklist program. Twenty-nine essential practices that target the major causes of childbirth-related mortality, such as hand hygiene and uterotonic administration, were evaluated. The primary end point was the average rate of successful delivery of essential childbirth practices by health workers. Delivery of essential childbirth-related care practices at each birth event increased from an average of 10 of 29 practices at baseline (95%CI 9.4, 10.1) to an average of 25 of 29 practices afterwards (95%CI 24.6, 25.3; p<0.001). There was significant improvement in the delivery of 28 out of 29 individual practices. No adverse outcomes relating to the intervention occurred. Study limitations are the pre-post design, potential Hawthorne effect, and focus on processes of care versus health outcomes.ConclusionsIntroduction of the WHO Safe Childbirth Checklist program markedly improved delivery of essential safety practices by health workers. Future study will determine if this program can be implemented at scale and improve health outcomes.

Improving Quality of Care for Maternal and Newborn Health: Prospective Pilot Study of the WHO Safe Childbirth Checklist Program

Improving Quality of Care for Maternal and Newborn Health: Prospective Pilot Study of the WHO Safe Childbirth Checklist Program

Pressure-volume-temperature relations of water in the range 400-1000 C and 100-1400 bars, Part 5 of Properties of water

<b>Background</b> Although there are many evidence-based practices that reduce the risk of maternal and neonatal mortality around the time of birth, there remains a gap between what is known and the care received. This know-do gap is a source of preventable maternal and perinatal deaths and is the focus of improvement efforts in many countries. Following an increase in perinatal and maternal deaths, Gobabis District Hospital initiated a quality improvement (QI) initiative to increase adherence to these WHO Safe Childbirth Checklist (SCC)-targeted essential birth practices (EBPs). <b>Methods</b> We implemented the SCC with support from leadership, coaching and organisational redesign. Implementation was led by a facility champion supported by a QI team and adapted through a series of three 8-week Plan–Do–Study–Act (PDSA) cycles. <b>Results</b> During the 6-month period, we observed an improvement of average EBPs delivered from 68% to 95%. We also found reductions in perinatal mortality rates from 22 deaths/1000 deliveries to 13.8/1000 deliveries largely due to a drop in fresh stillbirths. <b>Conclusion</b> We conclude that replicating the programme is feasible, acceptable and effective in areas where gaps exist, but it requires local leadership, ongoing coaching and adaptation through PDSA cycles.