WHO Better Outcomes in Labour Difficulty (BOLD) project: innovating to improve quality of care around the time of childbirth

Abstract

As most pregnancy-related deaths and morbidities are clustered around the time of childbirth, quality of care during this period is critical to the survival of pregnant women and their babies. Despite the wide acceptance of partograph as the central tool to optimize labour outcomes for over 40 years, its use has not successfully improved outcomes in many settings for several reasons. There are also increasing questions about the validity and applicability of its central feature – “the alert line” – to all women regardless of their labour characteristics. Apart from the known deficiencies in labour care, attempts to improve quality of care in low resource settings have also failed to address and integrate women’s birth experience into quality improvement processes. It was against this background that the World Health Organization (WHO) embarked on the Better Outcomes in Labour Difficulty (BOLD) project to improve the quality of intrapartum care in low- and middle-income countries. The main goal of the BOLD project is to reduce intrapartum-related stillbirths, maternal and newborn mortalities and morbidities by addressing the critical barriers to the process of good quality intrapartum care and enhancing the connection between health systems and communities. The project seeks to achieve this goal by (1) developing an evidence-based, easy to use, labour monitoring-to-action decision-support tool (currently termed Simplified, Effective, Labour Monitoring-to-Action – SELMA); and (2) by developing innovative service prototypes/tools, co-designed with users of health services (women, their families and communities) and health providers, to promote access to respectful, dignified and emotionally supportive care for pregnant women and their companions at the time of birth (“Passport to Safer Birth”). This two-pronged approach is expected to positively impact on important domains of quality of care relating to both provision and experience of care. In this paper, we briefly describe the rationale for innovative thinking in relation to improving quality of care around the time of childbirth and introduce WHO current plans to improve care through research, design and implementation of innovative tools and services in the post-2015 era.Please see related articles ‘http://dx.doi.org/10.1186/s12978-015-0029-4’ and ‘http://dx.doi.org/10.1186/s12978-015-0028-5’.

Autonomia feminina no processo de parto e nascimento: revisão integrativa da literatura

“…However, these rights and the preconditions for health and citizenship have been gradually violated. The current obstetric care model is characterised by growing dependence on technical and technological interventions and the wide use of C-section as a way of birth, which has expropriated women of the control over their bodies and of their autonomy (4)(5) .…”

Healthcare providers’ perspectives on labor monitoring in Nigeria and Uganda: A qualitative study on challenges and opportunities

“…The discussion guides included the following domains (full discussion guides are available as Supporting Information ): (1) exploring the meaning of quality childbirth care; (2) expectations and needs to provide quality childbirth care; (3) barriers and facilitators to the provision of quality childbirth care, focusing on labor monitoring; (4) potential changes to enhance the provision of quality childbirth care, across women, community, provider, facility, and health system levels; and (5) perceived expectations and needs of women seeking facility‐based intrapartum care. This analysis focuses on the data relating to labor monitoring, as this was the aspect that was of specific importance to the conceptualization of SELMA …”

“…We formed the discussion groups within each cadre of providers, such that the participants from the same cadre were similar in terms of their clinical or managerial roles. For IDIs, participants within each cadre were further selected based on their age and work experience to maximize the variation and to increase the representativeness of the sample …”

“…The Better Outcomes in Labor Difficulty (BOLD) project was launched by the WHO with the goal of reducing intrapartum‐related maternal, fetal, and newborn mortality and morbidity . Specifically, the BOLD project focused on the development of: (1) a Simplified, Effective, Labor Monitoring‐to‐Action tool (SELMA) to assist healthcare providers with labor monitoring and decision‐making processes; and (2) tools to generate demand and promote women's access to respectful, quality care during childbirth (“Passport to Safer Birth”) . SELMA is envisioned as an electronic tool designed to enhance human expertise and optimize the outcomes of labor and childbirth .…”

Using a service design model to develop the “Passport to Safer Birth” in Nigeria and Uganda

“…In 2014, the WHO initiated the “Better Outcomes in Labour Difficulty” (BOLD) project to address the quality of facility‐based childbirth care in low‐resource settings. The goal of this project is to accelerate the reduction of childbirth‐related maternal, fetal, and newborn mortality and morbidity by addressing critical impediments in the process of labor and childbirth care, taking advantage of the interactions between the health system and the community . The project sought to achieve this goal through a two‐pronged approach: the development of a Simplified, Effective, Labour Monitoring‐to‐Action tool (SELMA), and the creation of a Passport to Safer Birth (PSB) .…”