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Programming for safe motherhood: a guide to action.

M A Koblinsky·A Tinker·P Daly
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Abstract

The Safe Motherhood Initiative has successfully stimulated much interest in reducing maternal mortality. To accelerate programme implementation, this paper reviews lessons learned from the experience of industrial countries and from demonstration projects in developing countries, and proposes intervention strategies of policy dialogue, improved services and behavioural change. A typological approach with three hypothetical settings from resource poor to resource rich environments is used to address the variability in health behaviours and infrastructure encountered when programming for safe motherhood.

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Delivery, ObstetricDeveloping CountriesFemaleHealth PolicyHealth StatusHumansLabor, ObstetricMaternal Health ServicesMaternal MortalityNutritional StatusPregnancyPregnancy ComplicationsRisk FactorsSocioeconomic FactorsUnited StatesCommunity Health ServicesDelivery Of Health CareDemographic FactorsFamily And HouseholdFamily CharacteristicsFamily RelationshipsHealthHealth ServicesHealth Services EvaluationInternational AgenciesMaternal HealthMaternal-child Health ServicesMortalityMothersOrganization And AdministrationOrganizationsParentsPopulationPopulation DynamicsPrimary Health CareProgram DesignProgram EvaluationProgramsQuality Of Health CareRecommendationsUnWorldJournal ArticleResearch Support, Non-U.S. Gov'tResearch Support, U.S. Gov't, Non-P.H.S.Review

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M A Koblinsky, A Tinker, P Daly. 1994. Programming for safe motherhood: a guide to action.. https://doi.org/10.1093/heapol%2F9.3.252

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Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of teamwork training on the occurrence of adverse outcomes and process of care in labor and delivery. METHODS: A cluster-randomized controlled trial was conducted at seven intervention and eight control hospitals. The intervention was a standardized teamwork training curriculum based on crew resource management that emphasized communication and team structure. The primary outcome was the proportion of deliveries at 20 weeks or more of gestation in which one or more adverse maternal or neonatal outcomes or both occurred (Adverse Outcome Index). Additional outcomes included 11 clinical process measures. RESULTS: A total of 1,307 personnel were trained and 28,536 deliveries analyzed. At baseline, there were no differences in demographic or delivery characteristics between the groups. The mean Adverse Outcome Index prevalence was similar in the control and intervention groups, both at baseline and after implementation of teamwork training (9.4% versus 9.0% and 7.2% versus 8.3%, respectively). The intracluster correlation coefficient was 0.015, with a resultant wide confidence interval for the difference in mean Adverse Outcome Index between groups (-5.6% to 3.2%). One process measure, the time from the decision to perform an immediate cesarean delivery to the incision, differed significantly after team training (33.3 minutes versus 21.2 minutes, P=.03). CONCLUSION: Training, as was conducted and implemented, did not transfer to a detectable impact in this study. The Adverse Outcome Index could be an important tool for comparing obstetric outcomes within and between institutions to help guide quality improvement. CLINICAL TRIAL REGISTRATION: (www.ClinicalTrials.gov), NCT00381056 LEVEL OF EVIDENCE: I.

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