In collaboration with the World Health Organization, we are piloting the use of the “Safe Birth Checklist” to support the delivery of essential maternal and perinatal care practices to reduce maternal and neonatal mortality. The Safe Childbirth Checklist originated from the success of the safe surgery checklist program, developed by Dr. Atul Gawande in India, and now used all over the world.
Quick facts about maternal and neonatal deaths
- There are more than 130 million births that take place each year.
- About 1 million of these children are stillborn due to intrapartum-related causes. These stillbirths often result from complications during labor, and most of these deaths are avoidable if existing knowledge were applied.
- Additionally, about 287,000 mothers a year die as a result of childbirth, and another 3.1 million children die during the neonatal period.
- The highest incidence of maternal and perinatal mortality occurs around the time of birth with the majority of deaths occurring within the first 24 hours after delivery.
The major causes of childbirth-related deaths are:
- Hemorrhage, infection, hypertension-related disorders and prolonged or obstructed labor in mothers.
- Infection, birth asphyxia and complications of prematurity in babies.
Checklists: a solution to save lives and resources
Checklists can remind even the best-trained surgeons and best-equipped teams about critical steps and help them communicate with one another, their medical teams and the patients.
Making the work of health care providers easier to remember and communicate might save as many lives as the most effective drug. In The Checklist Manifesto: How to Get Things Right, author and physician Atul Gawande tells a remarkable story about how checklists, used for decades by teams of pilots and construction workers, were found to cut the death rate from surgery in poor and rich countries alike by nearly 50 percent.
Many simple solutions in health care, such as providers washing their hands, become complex as irregular medical teams react to patient needs. Gawande found that checklist items reminding surgical team members to introduce themselves to one another and ask whether there were concerns that should be raised could lead to, among other things, providers noting to one another that their hands needed to be washed. As a result, infection and death rates are lowered.
We believe checklists for both expected and unexpected childbirth complications may be one of the most potent interventions in health care.
Provision of skilled attendance at every birth is a global priority for achieving the Millennium Development Goals, and many countries have organized efforts to encourage women to deliver in health facilities to ease the management of complications. Despite major efforts around the world to improve quality of care, gaps in newborn and maternal care practices continue. Checklists can remind providers of the minimum critical standards around delivery care that can prevent avoidable maternal and neonatal deaths.
Making a difference
PSI/India and partners have assembled a 31-item list of reminders, from simple ones, such as asking the mother’s companion to be present at the birth, to more precise clinical signs of infection and hemorrhage. The aim of the pilot is to test whether childbirth-related harm, including death, in institutional deliveries in India can be significantly reduced through adherence to essential childbirth-related clinical care standards.
In the state of Uttar Pradesh, 120 rural public sector facilities in 20 districts that deliver at least 1,000 babies per year have been paired and randomized either to use the checklist or not. PSI/India will help clinics adopt the checklist and manage information for the 172,800 births that need to be monitored. The study is projected to be finished in 2015.
- Learning Before Leaping: Integration of an Adaptive Study Design Process Prior to Initiation of BetterBirth
This paper describes how an initial trial of BetterBirth, an intervention using the WHO Safe Childbirth Checklist, was modified and implemented in additional facilities in Uttar Pradesh, India, in order to collect stronger evidence of the program's impact on essential birth practices and maternal and neonatal health.