Improved Childcare

A study co-authored by an Indian American physician, Dr. Atul Gawande, has revealed that a checklist and coaching intervention to improve facility-based childbirth care and reduce deaths of women and newborns in India achieved significant gains in the quality of care during labor and delivery. (Harvard.edu photo)

A study, co-authored by Indian American physician Dr. Atul Gawande, revealed that a checklist and coaching intervention to improve facility-based childbirth care and reduce deaths of women and newborns in India achieved significant gains in the quality of care during labor and delivery.

The BetterBirth study, which appears in the Dec. 14 issue of the New England Journal of Medicine, added that the improvements were insufficient, however, to reduce death rates, according to a Harvard University news report.

The study is one of the largest ever conducted in maternal-newborn health, with more than 300,000 women and newborns, the report said.

It is also the first study to rigorously demonstrate large-scale, broad-based improvement in care during the 48-hour period of labor and delivery when women and newborns face the greatest risk of death and complications, it added.

The research, supported by the Bill & Melinda Gates Foundation, was led by Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital in Boston, in partnership with the governments of India and Uttar Pradesh; Community Empowerment Lab in Lucknow, India; Jawaharlal Nehru Medical College in Belgaum, India; Population Services International; and the World Health Organization.

“This was the first rigorous study of deploying checklists and coaching at large scale,” said Ariadne Labs executive director Gawande, a Harvard Chan School professor and senior co-author, who helped lead the development of the Safe Childbirth Checklist with WHO.

“The results demonstrated impressive behavior change. Now we in public health must identify the additional ingredients required to produce the complete recipe for saving lives at childbirth,” Gawande added.

The quality of care around the time of childbirth has been recognized globally as a major contributor to the persistently high rates of preventable maternal and infant deaths in childbirth, even though more women are delivering babies at facilities, according to the report.

The WHO’s Safe Childbirth Checklist was designed to target the seven major causes of death by helping birth attendants consistently follow basic practices such as handwashing and use of clean gloves to prevent infection, it said.

In this randomized study conducted from 2014 to 2016, birth attendants and managers at 60 rural health centers in Uttar Pradesh were coached on use of the WHO’s Safe Childbirth Checklist. After two months of coaching, birth attendants completed 73 percent of the essential birth practices, 1.7 times better than the control arm at 42 percent, the report noted.

At 12 months, four months after the coaching ended, completion of checklist items persisted at 62 percent, 1.4 times better than control facilities, which remained unchanged, it added.

There was no difference between intervention and control sites, however, in stillbirths, seven-day newborn mortality and seven-day maternal mortality and morbidity.

“Overall, we found that coaching birth attendants and managers to use the WHO Safe Childbirth Checklist produced greater adherence to essential birth practices, representing significant improvements in care for women and newborns,” said BetterBirth director Dr. Katherine Semrau, an epidemiologist at Brigham and Women’s Hospital, assistant professor at Harvard Medical School, and lead author.

Gawande and his colleagues have focused their research on problems at the intersection of surgery and public health, according to his Harvard bio.

Much of their work has examined error in surgery, establishing its frequency and seriousness and revealing underlying mechanisms, it said.

Ongoing work ranges from observation research on performance and safety in the operating room to studies of medical malpractice claims to the development of technologies to prevent surgeons from inadvertently leaving sponges or instruments in patients, the bio added.

A newer area of research concerns the current state of care in developing countries for illness requiring surgery or other high technology interventions, it said.

A graduate of Stanford University (bachelor's), Oxford University (master's), Harvard Medical School and Harvard School of Public Health (M.P.H.), Gawande also writes the Notes of a Surgeon column for the New England Journal of Medicine and has been a staff writer for the New Yorker magazine since 1998.

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