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The Impact of Implementing an Evidence-Based Intrapartum Care Quality Improvement Program on Childbirth Outcomes for
Wenli Zhu1,2, Hui Min3, Yaming Dai3
1Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai Key Lab of Reproduction and Development, Shanghai Key Lab of Female Reproductive Endocrine Related Diseases, Shanghai, China, fudan.edu.cn.
Objectives:
To evaluate the impact of implementing an evidence-based intrapartum care quality improvement program on childbirth outcomes for laboring women.
Methods:
A quasiexperimental interrupted time series (ITS) study using routinely collected hospital data was conducted at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. The study period spanned from November 1, 2021, to December 31, 2022, with a 4-month preparation phase (April 1, 2022, to July 31, 2022) excluded from analysis. A total of 422 women were included (211 preintervention and 211 postintervention), aggregated into 20 biweekly time points (10 preintervention and 10 postintervention). Key measures included intrapartum cesarean section (ICS) rates, oxytocin use, duration of labor, and childbirth experience scores. Sociodemographic and clinical data were extracted from routine records, and childbirth experience was assessed using the Childbirth Experience Questionnaire (CEQ 2.0).
Results:
Prior to the intervention, the ICS rate increased by 2.057% per biweekly time point (p = 0.015). After implementation, the ICS rate showed a decreasing trend, with a slope reduction of 2.782% compared with the preintervention trend (p = 0.018), resulting in an overall postintervention slope of -0.725% per biweekly time point. The estimated contribution of the intervention to ICS reduction was -22.69%. Compared with the preintervention group, women in the intervention phase had lower oxytocin use (71.09% vs. 80.09%, p < 0.05), shorter total labor duration (median 456.5 min [265.0-602.5] vs. 472.5 min [280.0, 670.0], p < 0.05), and higher childbirth experience scores (72.23 ± 9.76 vs. 69.27 ± 8.84, p < 0.05).
Conclusion And Implications For Nursing Management:
This quality improvement program effectively optimized intrapartum care through reduced medical interventions and enhanced childbirth experiences. Successful scaling up requires institutional commitment to midwifery continuity models, context-adaptive implementation strategies, and sustained investment in midwifery training and outcome monitoring systems to ensure equitable and woman-centered care delivery.