Safe childbirth checklist
The problem
There are nearly 300,000 maternal deaths, 3.1 million newborn deaths, and 1.2 million intrapartum-related stillbirths taking place in low-income countries each year, of which the vast majority are preventable.
The WHO Safe Childbirth Checklist
In 2008, the World Health Organization (WHO) established a checklist-based childbirth safety programme to support the delivery of essential maternal and perinatal care practices by health workers attending to institutional births. A 29-item bedside WHO Safe Childbirth Checklist has been developed according to previously established methodology and tested for usability in ten countries in Africa and Asia.
Items on the checklist address the major causes of maternal deaths (i.e., hemorrhage, infection, obstructed labour, and hypertensive disorders), intrapartum-related stillbirths (i.e., inadequate intrapartum care), and neonatal deaths (i.e., birth asphyxia, infection, and complications of prematurity) in low income countries.
An implementation programme has also been designed to maximize the likelihood of successful checklist adoption into clinical practice, and an initial pilot test of this checklist-based programme was recently completed at a district level hospital in Karnataka State, India with promising results. Several of the process measures studied improved by at least 50% with implementation of the checklist.
Article
The study appears in the May 16, 2012 online edition of PLoS One.
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Improving Quality of Care for Maternal and Newborn Health: Prospective Pilot Study of the WHO Safe Childbirth Checklist Program
Jonathan M. Spector, Priya Agrawal, Bhala Kodkany, Stuart Lipsitz, Angela Lashoher, Gerald Dziekan, Rajiv Bahl, Mario Merialdi, Matthews Mathai, Claire Lemer, Atul Gawande
Next Steps
A large randomized controlled trial funded by the Bill and Melinda Gates Foundation is under way in Uttar Pradesh, India, to evaluate the impact of this checklist-based patient safety programme on maternal and newborn health outcomes. Results of the study are expected by 2015.
The Safe Childbirth Checklist programme represents a collaborative effort of the WHO Patient Safety Programme, the Department of Maternal, Newborn, Child and Adolescent Health, and the Department of Reproductive Health and Research and Harvard School of Public Health, in addition to many other experts from around the world.
WHO anticipates a draft release of the WHO Safe Childbirth Checklist by the end of the year.