Sexual and reproductive health

Engaging with communities is crucial for improving quality of care during childbirth

Special supplement on WHO “Better Outcomes in Labour Difficulty” (BOLD) study is published

15 December 2017: High-quality care for women giving birth in health facilities is crucial for safeguarding their health and well-being. Health care that is based on good quality scientific evidence goes a long way in helping to ensure such high-quality care – but it does not go far enough. The authors of a special supplement highlight how from the perspectives of individuals, their families and communities, high-quality care is that which is delivered with respect, with skill, and in accordance with their needs and preferences.

 Patients at the maternity ward of Reproductive Health Uganda's clinic in Mbale
Patients at the maternity ward of Reproductive Health Uganda's clinic in Mbale.
Jonathan Torgovnik

Formative research and development of innovative tools for “Better Outcomes in Labour Difficulty” (BOLD)

Published by the International Journal of Gynaecology and Obstetrics the special supplement shares some of the findings of the first phase of the WHO “Better Outcomes in Labour Difficulty” (BOLD) study. It is authored by staff at WHO Department of Reproductive Health and Research and HRP in collaboration with research partners in Nigeria, Uganda, and Finland.

What matters to people

The authors share how the central ethos of the WHO BOLD study, is to “work with local communities and service provision stakeholders to establish what matters for them, and what the likely solutions could be”. The papers highlight the results of the first stage of the study, which aimed to look at what good quality maternity care means for all those involved – including women, families, communities and care providers – and how this care can be provided.

Right decision, right moment

The papers also document labour progress, as well as medical interventions used during childbirth. The BOLD researchers, who are exploring labour progression and interventions, also aim to develop a “decision support system” – a tool to help health workers make the right decisions at the right time to support women when they are giving birth. This tool is called “SELMA”, which stands for “Simplified, Effective, Labour Monitoring-to-Action tool”.

Positive human relationships

The first four papers, which share the qualitative findings of BOLD research conducted in Uganda and Nigeria, show how for women, a positive human relationship between themselves and care givers is crucial for ensuring high-quality care.

Involving all

The authors of the supplement highlight how, in addition to listening to and gathering the perspectives of women, it is crucial for researchers to also record the views of all people who are involved, in order to bring to the surface the issues which are relevant to them. This includes other community members, midwives, nurses and doctors working the health facilities.

Translating qualitative evidence into standards

The BOLD study researchers show how that once perspectives from all local stakeholders have been documented, they can be then translated into standards for care. While such practice is still not common, it is important to include such qualitative evidence in the development of norms and standards. This is in order to ensure that health providers are not only equipped with a knowledge of high-quality scientific evidence, but also an awareness and understanding as to how care should be delivered, with an emphasis on skills, preferences and values.

WHO guidelines

The WHO recommendations on antenatal care for a positive pregnancy experience have already taken an important step in this direction, with their focus not only on a healthy pregnancy for mother and baby but also an effective transition to positive labour and childbirth and ultimately to a positive experience of motherhood.

Tools for local contexts

The BOLD study is unique in that integrated the standards which were developed collaboratively, into creating tools which are relevant for the local context. Aiming to be easy to use, the tools are closely linked to the views and perspectives for local stakeholders as to what quality care means. They aim to improve communication between all involved, and to ensure that women and their companions are better supported. This includes ensuring that their human rights are safeguarded and that they are treated with compassion and respect throughout their contact with the health system.