Singh Meenakshi, Puri Manju, Bessy Saji, Ranvir Singh Geeta, George Susan, Singh Abha, Yadav Reena
Professor Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
Obstetrics & Gynaecology, Lady Hardinge Medical College, New Delhi, India.
BMJ Open Qual. 2025 Jan 25;13(Suppl 1):e002294. doi: 10.1136/bmjoq-2023-002294.
Allowing a birth companion is the basic right of a mother and is identified as an important component of respectful maternity care. The implementation of this intervention has been a challenge in heavy-load public health facilities in India.
Despite the proven benefits of the presence of birth companions on maternal-fetal outcomes, there was no policy of allowing birth companions in our hospital.
We aimed to introduce and establish the practice of allowing birth companions for all eligible mothers admitted to the labour ward from 0% to 70% in 8 weeks duration. The study was conducted in the Department of Obstetrics and Gynecology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi. A quality improvement (QI) team was formed. After collecting the baseline data and observing the process flow, fishbone analysis was done to identify the main problems. Various change ideas were listed and tested in the form of plan-do-study-act (PDSA) cycles and ideas were either adapted or adopted. Simple interventions such as antenatal sensitisation and counselling of the mother and the family, WhatsApp groups, and monthly labour room induction classes for residents helped achieve the target. During COVID-19 pandemic, the practice of allowing birth companions was suspended temporarily but was rolled out again after the second wave of COVID-19 in COVID-19-negative and COVID-19 suspect labour wards.
The median value of the percentage of mothers accompanied by birth companions marginally increased to 20% after the first PDSA cycle. Finally, after multiple PDSA cycles, we could achieve our goal in 8 weeks. During a pandemic, the project was suspended temporarily during the first two waves but was revived again and we succeeded in reaching the desired goal and sustaining the policy after fewer PDSA cycles compared with the first phase.
The application of QI methodology and teamwork is pivotal in implementing any novel idea for patient care without additional infrastructure, manpower or financial resources.
允许有分娩陪伴者是母亲的基本权利，并且被视为尊重孕产妇护理的重要组成部分。在印度负荷繁重的公共卫生设施中，实施这项干预措施一直是一项挑战。
尽管分娩陪伴者的存在对母婴结局已证实有诸多益处，但我们医院没有允许分娩陪伴者的政策。
我们的目标是在8周内将允许所有符合条件的入住产房的母亲有分娩陪伴者的比例从0%提高到70%。该研究在新德里哈丁夫人医学院妇产科及苏切塔·克里普拉尼夫人医院开展。成立了一个质量改进（QI）团队。在收集基线数据并观察流程后，进行鱼骨分析以确定主要问题。列出各种变革想法，并以计划 - 实施 - 研究 - 行动（PDSA）循环的形式进行测试，对想法进行调整或采用。诸如对母亲及其家人进行产前宣传和咨询、建立WhatsApp群组以及为住院医生开展每月产房入门课程等简单干预措施有助于实现目标。在新冠疫情期间，允许分娩陪伴者的做法暂时中止，但在第二波新冠疫情后，在新冠病毒检测阴性和疑似感染新冠病毒的产房再次推行。
在第一个PDSA循环后，有分娩陪伴者陪伴的母亲比例的中位数略微增加到了20%。最终，经过多个PDSA循环，我们在8周内实现了目标。在疫情期间，该项目在前两波疫情期间暂时中止，但后来恢复，并且与第一阶段相比，我们在较少的PDSA循环后成功实现了预期目标并维持了该政策。
在不增加基础设施、人力或财力资源的情况下，应用QI方法和团队合作对于实施任何新的患者护理理念至关重要。
