in Labour Rooms 2 B y t he end o f t he sess i o n l ea r n e r s w il l be ab l e t o S t a t e t he t i m e s w hen ID: 999376
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1. Need for Improving Quality of Care in Labour Rooms
2. 2By the end of the session, learners will be able to:State the times when most mothers and newborns are dyingList major preventable causes of maternal and neonatal deaths in labor roomsDescribe the need for improving quality of care in labour rooms for better maternal and neonatal outcomeExplain the use of SCC as a tool for improving quality of care (QoC) and adhere to best evidence based practicesLearning Objectives
3. Source: The Lancet (DOI:10.1016/S0140-6736(14)60496-7)3Timing of Maternal DeathsProblem Statement: Most mortality is centred around delivery (intra and immediate postpartum period)Source:: JE Lawn et al.; Every newborn, progress, priorities and potential beyond survival; The Lancet (DOI:10.1016/S0140-6736(14)60496-7).Source: Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. The Lancet. 30 September;368(9542):1189–200.
4. 4Major Causes of Maternal Mortality and Interventions to Prevent themAMTSL, Oxytocin/ Misoprostol, Blood transfusionBP measurement,Anti hypertensive, MGSO4Antibiotics,IP, TT, 6 cleansMonitor labour with Partograph, LSCSFP andpost-abortion care
5. Source: The Lancet (DOI:10.1016/S0140-6736(14)60496-7)5Timing of Neonatal DeathsProblem Statement 1: Most mortality is centred around delivery (intra and immediate postpartum period)Source:: JE Lawn et al.; Every newborn, progress, priorities and potential beyond survival; The Lancet (DOI:10.1016/S0140-6736(14)60496-7).Source: Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. The Lancet. 30 September;368(9542):1189–200.
6. Data source: ICMR-20066Antenatal corticosteroids, KMC, assisted feedingAntibiotics,IP, TT, 6 cleansImmediate breathing assessment, resuscitationCauses of Neonatal Deaths
7. Period of maximum risk for mother (and baby): Needs more focusWhere are women at the time of highest risk?Woman is in facility. Most interventions happen in labour rooms7
8. Our rates of institutional birth increased after JSY>75% increase in 5 years8
9. MMR declined but not proportionately9MMRYEAR
10. Decline in NMR is even slower5 points decline in ENMR in comparison to 8 points decline in NMR and 16 points decline in IMR Since 2005. This almost stagnant rate of ENMR indicates that more focus for care is needed on perinatal period. 10
11. What went wrong???XExpected result chain after JSYSource: AS/MD presentation at QoC workshop, Delhi 2013 Intra partum care did not improve as desired 11
12. Intra and immediate postpartum period- period of highest risk for mortality for both mothers and new-bornsHigh rates of institutional births since the advent of NHMReduction in maternal and neonatal mortality not commensurate with increase in institutional birthsQuality of care for intra and immediate postpartum period (care in labour rooms) at institutions needs improvementContext12
13. 13 What is needed?Wall et al. Int J Gyn & Obs 2009, 107: s47- s64Simple evidence based practices save lives136 million babies born Approx. 6 million babiesApprox. 10 million babies<1.4 million babies
14. What Does Quality of Care Mean?14
15. 15Need for Quality in ‘Normal’ LabourFHRBP MatTempMatPartographHistoryIPEquip readyAMTSLENBCTemp NBRR NBInf NBSkin to skinEBFBirth WtPPH assesDischarge counselingDanger Sign AdmissionDelivery1-2 hourDischargeIt may be challenging to ensure all practices are performed and performed at the right time
16. Resource availabilityFocused and customized trainingStrategy for transfer of learningImproved monitoring and accountabilityDakshata Dakshata
17. Training is focused on bare-minimum life saving practices to be performed during childbirthTraining introduces the Safe Childbirth Checklist (SCC) that will help you to:Know what essential actions need to be performed Know when to perform these actionsKnow how to perform these actionsSkill based sessions will help you build your capacity for essential interventionsJob aids given are based on GoI guidelines and will help you in your day to day workTips for organizing labor room will help you organize care betterThis training aims to enable you to adhere to all safe care practices during labour17
18. Most mortality is centered around intra and immediate post partum periodMajority of the causes of maternal and neonatal deaths are preventable through the use of evidence based practicesAfter JSY number of institutional deliveries have increased but reduction in MMR and IMR are not proportional to this increase so there is need to improve QoC in LRsSCC is a tool which helps to remember what, when and how to perform all activities during the time of delivery and immediate postpartum in a standardized way.Key Messages18