Recommendations From a National Panel on Quality Improvement in Obstetrics

Lefebvre, Guylaine; Calder, Lisa A.; Gorter, Ria De; Bowman, Cara; Bell, Douglas; Bow, Michael

doi:10.1016/j.jogc.2019.02.011

Cited by 5 publications

(4 citation statements)

References 2 publications

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“…The identified lack of interpersonal communication skills and attitudes is recognized as a significant weakness in obstetric training ( 50 ). Established guidelines for enhancing the quality of obstetric healthcare in countries such as Canada, position communication as a central resource ( 51 ). Additionally, within the healthcare context, the element of self-presentation to patients is acknowledged as a key communication aspect for establishing a supportive relationship ( 52 ).…”

Section: Discussionmentioning

confidence: 99%

Addressing obstetric violence: a scoping review of interventions in healthcare and their impact on maternal care quality

Yalley,

Jarašiūnaitė-Fedosejeva,

Kömürcü-Akik

et al. 2024

Front. Public Health

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BackgroundThe mistreatment and abuse of women during childbirth have been recognized as a major global health challenge, impeding facility-based delivery and contributing to the high maternal mortalities globally. The World Health Organization has specifically called for interventions to deal with obstetric violence. This scoping review consolidates the existing literature on interventions aimed at reducing obstetric violence and synthesizes existing knowledge on their impact in promoting respectful maternity care.MethodologyThirteen electronic databases were searched for relevant articles from January 2001 to March 2023. A total of 863 records were identified, and 72 full-text articles were retrieved for further screening. The review includes 16 studies, particularly from low- and middle-income countries, with interventions implemented at medical facilities and involving both women and healthcare providers. Eight of the studies were quantitative, three were qualitative and five used a mixed-methods approach.FindingsThe results reveal a promising trend in reducing obstetric violence through various interventions. Ten different types of interventions were identified, highlighting strategies to improve the quality of maternity care and enhance patient-centered care. Improved patient-provider communication skills, increased privacy measures, and reduced abuse and mistreatment emerged as common themes. Enhanced communication skills, including open discussions and the right to be informed, were crucial in reducing obstetric violence. Privacy measures, such as separate rooms, curtains, and birth companions effectively decreased incidents of non-confidential care. General abuse and mistreatment, including physical abuse and neglect, were also reduced, leading to improved perceptions of respectful care during childbirth.ConclusionOverall, the interventions had a favorable impact on obstetric violence reduction and women’s childbirth experiences. However, despite promising results, obstetric violence remains prevalent worldwide, necessitating more efforts to implement effective interventions. To the best of our knowledge, this is the first scoping review on obstetric violence interventions, providing a comprehensive overview of the state of the art. We suggest that further research is needed to explore new interventions, particularly gender-sensitive interventions, to contribute to a growing body of knowledge on the prevention of obstetric violence.

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Section: Discussionmentioning

confidence: 99%

Addressing obstetric violence: a scoping review of interventions in healthcare and their impact on maternal care quality

Yalley,

Jarašiūnaitė-Fedosejeva,

Kömürcü-Akik

et al. 2024

Front. Public Health

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“…Besides HBS main outcome (cesarean section rate), two sets of outcomes were selected to explore the impact of the PPA model: safety care measures and obstetric or neonatal outcomes. These sets of outcomes were largely based in outcome measures proposed in obstetric safety care studies, as well as obstetric care quality improvement initiatives [12,15,16]. The following measures were analyzed: Prelabor c-section; Repeated c-section (among women with at least one previous cesarean section); Prelabor c-section in women with prelabor rupture of membranes (PROM); Amniotomy during labor < 6 cm of cervical dilation; Group B Streptococcus positive women without prophylaxis during labor; C-section without antibiotic prophylaxis; Absence of postpartum (PP) prophylactic oxytocin; Severe hypertension without magnesium sulphate; Rhesus negative mother with a Rhesus positive baby without anti-D prophylaxis; and preterm birth < 34 weeks of gestational age without corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

“…However, it was not possible to identify a clear effect on safety care measures in the present analysis. These findings highlight the need to include strategies to improve the adoption of evidencebased practices associated with increased obstetric safety alongside QI projects aiming to reduce cesarean section rates [12,16].…”

Section: Or [95% Ci]mentioning

confidence: 97%

Impact of an intrapartum care quality improvement intervention in Brazilian private hospitals on care safety measures and adverse outcomes

et al. 2023

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Background In 2015, a quality improvement (QI) intervention to reduce cesarean sections (CS)—the Adequate Childbirth Project (PPA)—was implemented in the private sector in Brazil. This analysis aims to compare safety care measures and adverse outcomes between women exposed to the PPA intervention to those receiving standard care. Methods The analysis included a convenience sample of 12 private hospitals that participated in the PPA (2017–2018). Data collection was performed through chart review and interviews. Differences in 15 outcomes were examined using Pearson’s chi-square test and multiple logistic regressions. Results The final weighted sample was comprised of 4789 births, 2570 in the PPA group (53.5%) and 2227 in the standard care group (46.5%). CS rate was significantly lower in the PPA group (67.3% vs 88.8%). After adjusting for potential confounders, PPA model was associated with decreased overall CS rate (OR = 0.30, 95% CI 0.24 to 0.36), as well as prelabor (OR = 0.41, 0.34 to 0.48) and repeated CS (OR = 0.45, 0.29 to 0.70). In terms of other safety care measures, women in the PPA model had an increased chance of absence of antibiotic prophylaxis in Group B Streptococcus (GBS) + women (OR = 4.63, 1.33 to 16.14) and for CSs (OR = 1.75, 1.38 to 2.22), while those with severe hypertension were less likely to not receiving magnesium sulphate (OR = 0.27, 0.09 to 0.77). Regarding obstetric and neonatal outcomes, PPA model was associated with a decreased chance of having an obstetric anal sphincter injury (OASI) following an episiotomy (OR = 0.34, 0.13 to 0.89), requiring antibiotics other than routine prophylaxis (OR = 0.84, 0.70 to 0.99), having a late preterm (OR = 0.36, 0.27 to 0.48) or early term baby (OR = 0.81, 0.70 to 0.94). There were no statistically significant differences for other outcomes. Conclusions The PPA intervention was able to reduce CS rates, late preterm and early term deliveries without increasing the chance of adverse outcomes. The bidirectional effect on safety care measures reinforces that QI initiatives includes closer observation of routine care when implementing interventions to reduce C-section rates.

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“…Lack of skills and attitudes toward interpersonal communication comes across as a wide gap to bridge in obstetric training. This is why general guidelines to improve obstetric healthcare quality in countries such as Canada highlight communication as a resource set on a central axis [37]. It is also necessary to stress the presence of the professionals that women identified as "other" for each analyzed variable.…”

Section: Discussionmentioning

confidence: 99%

Obstetric Violence in Spain (Part III): Healthcare Professionals, Times, and Areas

Mena‐Tudela

Iglesias-Casás²,

Chorda

et al. 2021

IJERPH

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Background: Obstetric violence is a worldwide public health problem, which seems greater in Spain. As no studies were found that identify the most representative healthcare professionals, times, and areas involved in obstetric violence, the objective of this work was to study at what time of maternity, with which professionals, and in what areas women identified obstetric violence. Methods: This descriptive, retrospective, and cross-sectional study was performed from January 2018 to June 2019. The main variables were the area (hospital, primary care, both), the time (pregnancy, birth, puerperium), and the professionals attending to women. Results: Our sample comprised 17,541 participants. The area identified with the most obstetric violence for the different studied variables was hospitals. Women identified more obstetric violence at time of birth. Findings such as lack of information and informed consent (74.2%), and criticism of infantile behavior and treatment (87.6%), stood out. The main identified healthcare professionals were midwives and gynecologists, and “other” professionals repeatedly appeared. Conclusions: Having identified the professionals, times, and areas of most obstetric violence in Spain, it seems necessary to reflect on not only the Spanish National Health System’s structure and management but also on healthcare professionals’ training.

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Recommendations From a National Panel on Quality Improvement in Obstetrics

Cited by 5 publications

References 2 publications

Addressing obstetric violence: a scoping review of interventions in healthcare and their impact on maternal care quality

Addressing obstetric violence: a scoping review of interventions in healthcare and their impact on maternal care quality

Impact of an intrapartum care quality improvement intervention in Brazilian private hospitals on care safety measures and adverse outcomes

Obstetric Violence in Spain (Part III): Healthcare Professionals, Times, and Areas

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