BetterBirth Program improves childbirth care for mothers and babies with Safe Childbirth Checklist – Women Deliver

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June 7, 2016 Katherine Semrau Ariadne Labs

BetterBirth Program improves childbirth care for mothers and babies with Safe Childbirth Checklist


Every year, some 300,000 women and 2.7 million newborns die around the time of childbirth. The majority of these deaths occur in low-resource settings and are preventable.

The World Health Organization’s Safe Childbirth Checklist of 28 essential, lifesaving practices addresses the main causes of maternal and neonatal mortality. It synthesizes these evidence-based recommendations into a comprehensive bedside tool for facility-based birth attendants, beginning with a woman’s admittance to the hospital until her departure.

Ariadne Labs, a joint center of Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, has developed a comprehensive program around the Safe Childbirth Checklist called BetterBirth that optimizes its use in coordination with peer-to-peer coaching and data feedback to improve quality of care.

“Many important efforts, like increasing facility-based births, have helped lower maternal and neonatal mortality over the years, but the numbers remain unacceptably high,” said BetterBirth Director Dr. Katherine Semrau, an epidemiologist with nearly two decades of experience in maternal and newborn health. “We can do better. Our model in BetterBirth aims to improve the quality of care happening in facilities during childbirth. We hope that by working directly on the frontline of labor and delivery with birth attendants, we can make a difference for women and babies.”

The BetterBirth approach to checklist implementation is being tested in large randomized controlled trial led by Ariadne Labs in partnership with Population Services International, World Health Organization, the governments of India and Uttar Pradesh, Community Empowerment Lab and Jawaharlal Nehru Medical College.

Photos via Ariadne Lab

The trial is operating at 120 medical facilities enrolling more than 150,000 mother and infant pairs in Uttar Pradesh, India, where maternal and neonatal death rates exceed the national average.

“Part of the goal of the trial is to figure out what behaviors are changing, what are not, and how that impacts mortality and morbidity,” said Dr. Semrau. “We know the checklist can be a powerful tool, but it can’t work alone.”

While the trial will continue until 2017, the BetterBirth study team is already reporting some exciting findings around the quality of care delivered by birth attendants.  “Out of 18 evidence-based practices, the control sites have incorporated seven actions, while at the intervention sites we are seeing 13,” said Semrau, indicating that the support model is effective in changing behavior.

In the control sites, birth attendants rarely practice some of the behaviors on the checklist. For example, less than 10 percent of mothers were having their blood pressure taken; hand washing before vaginal exams was very low, and skin-to-skin contact between mother and child within the first hour of life was less than 20 percent. 

The checklist and accompanying implementation guide identifies four pause points, allowing birth attendants to conduct checks at times when they can protect the mother and newborn against dangerous complications. In providing support to the frontline care professionals, the focus is on empowering them, and getting them excited about providing quality care.

“The checklist helps streamline and organize the birth attendant’s work around childbirth,” said Semrau. “Along with the peer coaching and data feedback, that empowers the birth attendant to recognize deficiencies and improve the quality of care they are providing.”

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