Implementing evidence-based practices in childbirth: The "Better Births" initiative (BBI)

In the past two decades, considerable evidence has been produced regarding the effectiveness or otherwise of childbirth procedures. Evidence from randomized trials has been synthesized in systematic reviews published in the Cochrane Library and the WHO Reproductive Health Library (RHL). The RHL is distributed by free subscription to health workers in low-income countries.
Despite the availability of evidence, surveys in resource-poor countries show that women using state maternity services are often subjected to uncomfortable and degrading procedures for which there is no evidence of benefit. They will then avoid services where there is a community perception of poor quality obstetric care.
Procedures for which there is no evidence of effectiveness include confinement to bed, routine starvation, routine early amniotomy, birth in the supine position and routine episiotomy. Procedures with evidence of effectiveness include childbirth companionship, magnesium sulphate for eclampsia, and active management of the third stage of labour.
The Births Initiative (BBI) is a new strategy developed by health professionals in South Africa and internationally, to help provide a better quality of childbirth care for women and improve maternal outcomes in low-income countries.
The purpose of the initiative i.s to improve the quality of care by encouraging health care workers to abandon practices that are painful, uncomfortable, and potentially harmful and have no evidence of benefit, and to implement effective procedures. This means women will have a better experience of childbirth.
Principles of the BBI:
Humanity : women to be treated with respect
Benefit: care that is based on the best available evidence
Commitment: health professionals committed to improving care
Action: effective strategies to change current practices
BB1 Materials
These include a workbook, posters, video presentation, a slide power point presentation of best evidence for procedures during labour, a reference booklet, and a self-audit mechanism. The video programme shows real experiences of implementing companionship in labour wards in South Africa.
The BBI materials are available free of charge on the WHO Reproductive Health Library, from [email protected] , and on the BBI website: http://www.liv.ac.uk/lstm/EHCP.html. Accessing these materials and the evidence on childbirth procedures from the RHL will be demonstrated during the presentation.