The randomised controlled ‘BetterBirth’ study included more than 300,000 women and babies in primary care facilities in Uttar Pradesh, India – an area with one of the highest birth-related mortality rates in the country.
60 birth attendants and managers were enrolled in an eight-month coaching programme on how to use the WHO Safe Childbirth Checklist (interventions), with 60 rural health centres in Uttar Pradesh being used as controls.
The study found that the Safe Childbirth Checklist, developed by the World Health Organization, did not lead to a reduction in the overall death rate for women and babies.
Co-author of the paper, Professor Lisa Hirschhorn, commented on the study saying: “The team is looking into why the improvements did not translate into reduction of maternal and neonatal harm. Some possibilities might include the changing causes of death to those which are not preventable by the checklist items, requiring more complex care such as care for premature infants, other quality of care challenges and gaps in higher-level care for women and their neonates with complications.”
The Safe Childbirth Checklist addresses the major causes of death through the promotion of 28 essential birth practices such as clean gloves to prevent infection, monitoring blood pressure to prevent eclampsia and steps to prevent maternal haemorrhage.
Two months into the study, researchers found that birth attendants and midwives at the intervention sites had performed 73% of the essential birth practices, in comparison to 42% performed by controlled health centres.
However, the results of the study showed no noticeable improvement in childbirth care with the use of the Safe Childbirth Checklist.
Researchers also found no significant impact on perinatal and mortality rates, or complications between both the intervention and control sites.
The BetterBirth study was supported by the Bill & Melinda Gates Foundation, and led by Adriadne Labs, a joint centre 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.
The outcomes of the ‘BetterBirth’ study can be found here.
Keep up to date with the latest research and news from MIDIRS by subscribing to our quarterly academic journal. Subscribe to MIDIRS Midwifery Digest