Quality of routine essential care during childbirth: clinical observations of uncomplicated births in Uttar Pradesh, India

Abstract

ObjectiveTo evaluate the quality of essential care during normal labour and childbirth in maternity facilities in Uttar Pradesh, India.MethodsBetween 26 May and 8 July 2015, we used clinical observations to assess care provision for 275 mother–neonate pairs at 26 hospitals. Data on 42 items of care were collected, summarized into 17 clinical practices and three aggregate scores and then weighted to obtain population-based estimates. We examined unadjusted differences in quality between the public and private facilities. Multilevel linear mixed-effects models were used to adjust for birth attendant, facility and maternal characteristics.FindingsThe quality of care we observed was generally poor in both private and public facilities; the mean percentage of essential clinical care practices completed for each woman was 35.7%. Weighted estimates indicate that unqualified personnel provided care for 73.0% and 27.0% of the mother–neonate pairs in public and private facilities, respectively. Obstetric, neonatal and overall care at birth appeared better in the private facilities than in the public ones. In the adjusted analysis, the score for overall quality of care in private facilities was found to be six percentage points higher than the corresponding score for public facilities.ConclusionIn 2015, the personnel providing labour and childbirth care in maternity facilities were often unqualified and adherence to care protocols was generally poor. Initiatives to measure and improve the quality of care during labour and childbirth need to be developed in the private and public facilities in Uttar Pradesh.

Quality of free delivery care among poor mothers in Gujarat, India: A community-based study

“…Numerous studies done in India and comparative studies in Southeast Asia indicate that perception of quality of care is important in deciding where to deliver. [ 16 17 18 19 20 21 22 ] Our findings are consistent with a similar study in Nepal that suggests women perceived private facilities to be higher on the scale of quality for better privacy, improved infrastructure, and more cleanliness. [ 17 ] In our study, mothers perceived that quality of care provided in private sector compared to public sector was better.…”

“…[ 23 24 25 ] The comparison of public and private sector in Uttar Pradesh shows that quality of care observed during the births was better in private facilities compared to public sector. [ 20 ]…”

Is quality of care during childbirth consistent from admission to discharge? A qualitative study of delivery care in Uttar Pradesh, India

“…Door-to-door observation of the entire journey of a woman’s experience of delivery care allowed identification of critical gap areas specific to each of the five stages. Few other studies have similar in-depth documentation [ 22 , 27 , 46 – 48 ]. These studies were conducted in similar settings—Ethiopia; Nigeria; UP and MP in India and most of them used direct observations of intrapartum care provided during labour and childbirth except one in Nigeria that employs a different qualitative approach to capture the experiences of providers and women.…”

“…According to a hospital-based cross-sectional study conducted in Netherland the active third stage management was being adequately performed in only close to half of all vaginal deliveries [ 54 ]. Other gaps include inappropriate maternal and newborn infection management, not providing immediate skin to skin contact and no assessment of newborn’s health [ 22 , 46 , 55 ]. Gaps in patient safety included providers not performing hand hygiene before wearing sterile gloves, instruments not being sterilized; and improper disposal of sharps.…”

Evidence-based intrapartum practice and its associated factors at a tertiary teaching hospital in the Philippines, a descriptive mixed-methods study.

“…However, studies have identified gaps between recommended and actual practices [2]. Essential routine monitoring and assessment during labour as well as key practices are not sufficiently conducted, compounded by inappropriate infrastructures and supplies [3][4][5]. Mistreatment and abusive actions, including unnecessary interventions, are also common in health facility deliveries [4,6].…”