Translating evidence into practice in childbirth: a case from the Occupied Palestinian Territory.

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.