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Translating evidence into practice in childbirth: a case from the Occupied Palestinian Territory
Sahar J Hassan1, Johanne Sundby, Abdullatif Husseini
1Section of Preventive Medicine and Epidemiology, Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway. sjamal@birzeit.edu
Objective:
To investigate possible changes in practices during normal childbirth by implementing interventions which reduce the frequency of: intravenous fluids; bladder catheterization; analgesia; artificial rupture of membranes; oxytocin use for augmentation; vaginal examination; episiotomy, and increase: mobility; oral intake of fluids; and initiation of immediate breastfeeding.
Design:
An operational research design.
Setting:
A referral governmental hospital in the Occupied Palestinian Territory (oPt) between 2006 and 2010.
Participants:
2345 women (baseline: 134 women, intervention: 1860 women, post-intervention: 351 women) and 17 providers (10 midwives and 7 physicians).
Interventions:
Multifaceted interventions; a combination of on-the-job training, audit, and feedback, supported by a core team and informal meetings.
Main Outcome Measures:
Change of practices during normal childbirth according to best evidence and the WHO recommendations.
Findings:
Significant sustained improvements in practices during childbirth from baseline to post-intervention including artificial rupture of membranes, liberal use of oxytocin to augment normal labour, intravenous fluids, frequency of vaginal examinations, oral intake, immediate breastfeeding and routine episiotomy (P<0.005). There was positive change in the mobility during labour, but this change was not sustained after 9 months from intervention to post-intervention. The usage of analgesia did not change.
Key Conclusions:
Certain changes in practices during normal childbirth were possible in this hospital. A combination of on-the-job training with other interactive approaches increased midwives' awareness, capacities and self-confidence to implement fewer interventions during normal labour.
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