BETTER BIRTH INITIATIVES- GRANDROUND PRESENTATION

8/7/2019 BETTER BIRTH INITIATIVES- GRANDROUND PRESENTATION

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EVIDENCE BASED MIDWIFERYPRACTICE

1.BETTER BIRTH INITIATIVES

A PRESENTATION FOR NURSES AND MIDWIVES GRANDROUND

OBS/GYNAE DEPARTMENT



Best evidence forBest evidence forpractices duringpractices duringlabourlabour

Presentation prepared forPresentation prepared for

the Better Births Initiativethe Better Births Initiative



EvidenceEvidence- -based medicinebased medicine

(EBM) is...(EBM) is...

...the conscientious, explicit, and judicious use of current best evidence inmaking decisions about the care of individual patients.

Sackett et al, 1996



EvidenceEvidence- -based health carebased health care

Without clinical expertise, evidencemay not be applicable to or appropriatefor an individual patient.

Without current best evidence, practicewill rapidly become out of date.



Principle of EBMPrinciple of EBM

In healthcare, the overall objective

is to deliver interventions that:

do more good than harmdo more good than harm



Part I:Part I:

Why do we need to useevidence in our clinicalpractice?



Good practice forchildbirth care



BackgroundBackground

In developing countries many womengive birth in state maternity facilities

Surveys show that women have negativeexperiences



Best evidence versus traditionalBest evidence versus traditionalbeliefsbeliefs

Are our traditional obstetricAre our traditional obstetricpractices based on evidence of practices based on evidence of

effectiveness?effectiveness?



Mobility duringMobility during labourlabour

Traditional belief

Bedrest bestBest evidence

Improved progress

of labour if mobile



Different positions for birth

Different positions for birthTraditional belief

Supine position best

access for attendantSupine safest position

Best evidence

Supine -progressive

acidosis of baby, slowerprogressOther positions (lateral tilt,upright, squatting) lesspain, less vaginal trauma,improved fetal outcome



F luids and food during labourF luids and food during labour

Traditional belief

Risk of inhalation if

general anaestheticneededKeep everyone nil permouth

Best evidence

No difference in

anaesthetic riskDehydration p

acidosis, fetal distressNil per mouth only forspecific reason



Encourage childbirthEncourage childbirth

companionshipcompanionshipBest evidence

Better progress of labour

Fewer Caesarean sectionsLess painMore self-esteemBetter relationship withbabyMore breast-feedingLess depression

Traditional belief

Companions

discouraged± Worries about

infection± Get in the way

± Lack of privacy± Staff overworked



Enemas in labourEnemas in labour

Traditional belief

Necessary to avoid

soilingUse routinely

Best evidence

No difference in

soiling (moreliquid)Use only if requested



Stop shaving forStop shaving for labourlabour

Shaving

advocated:

To facilitatesuturing

To reduceinfection

Problems:Painful, embarrassing

Re-growthuncomfortableMicroabrasions causeinfectionNo benefits shownRisk of HIV transmission



Avoid episiotomyAvoid episiotomy

Traditional belief

Clean incision easier

to repairHeals betterFewer 3° tearsUse routinely

Best evidence

More perineal trauma

More suturing neededMore complicationsUse only when absolutelynecessary



Part II:Part II:

In troduci ng evide n cebased mater n ity care



Changing practice

Changing practice

Obstacles to changing practice are

dauntingIf initial apprehension of staff isovercome, benefits will become self-evidentWith commitment from staff, changecan be achieved



The Better Births InitiativeThe Better Births Initiative

This is a global initiative thatpromotes humane and evidencebased care for women duringchildbirth.



The Better Births PrinciplesThe Better Births Principles

Humanity:Humanity: women treatedwith respect

Benefit:Benefit: care that isbased on thebest availableevidence

Commitment:Commitment: health professionalscommitted to

improving careAction:Action: effective strategies

to change currentpractice



BBI standardsBBI standards

Use procedures that are effective andbeneficial:

Mobility during labourDifferent positions for birth

Companionship




Stop using procedures that have nobenefit:

Supine position for birthWitholding fluids and food

Enemas

Shaving



BBIBBI BBIBBI standardsstandards

Avoid making interventions routinewhen there is no evidence of benefit:

Routine episiotomyRoutine suction of neonates withoutmeconium exposure

Routine artificial rupture of membranes




Identify other priority areas, and takesteps to bring about change:

Magnesium sulphate for eclampsiaOxytocin in third stage

Strategies to reduce MTCT of HIV

Steroids for preterm deliveryAntibiotics for Caesarean section

Use of the partogram



Change is never easyChange is never easy

Moving towards Better Births will take a lot of time, energy and commitment.The Better Births Initiative provides thematerials to bring about real change for thebetter.It s up to each one of us to take up thechallenge.

BETTER BIRTH INITIATIVES- GRANDROUND PRESENTATION

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