By Oscar Abello
Every health worker, nurse, doctor, midwife, medical technician, hospital maintenance worker and their family and friends know how stressful and chaotic life can be for someone in the global health workforce. One of the most stressful and chaotic moments is childbirth:
Imagine this. You’re a staff nurse at a rural hospital in Uttar Pradesh, one of India’s poorest states, and you’re responsible for deliveries at the busy facility. The other staff nurse didn’t show up, and you have no doctor onsite for backup, a common occurrence. You have six women in recovery, one woman with the baby crowning, and multiple other responsibilities tugging at you. You had a training course in safe birth practices, but the list of things you were expected to do was more than you could memorize. And no one ever explained how you were supposed to pull all of it off in the chaos of a real birth center anyway.
Then the baby is born, and she’s blue. She’s not breathing. Your heart starts racing. It comes back to you that you were supposed to have a bag mask ready for resuscitation of the newborn. But now what are you supposed to do?
That description comes from the Impatient Optimists blog, where Mariam Claeson, physician Atul Gawande and Aparajita Ramakrishnan wonder are checklists are a game-changer for saving lives at birth?
A multi-year research program is underway to address that challenge in 120 public hospitals across Uttar Pradesh. The BetterBirth trial aims to rigorously test whether practical changes in health workers’ behavior – applying WHO’s Safe Childbirth checklist – can actually reduce major harm and save lives when they are most in danger.
The checklist idea was originally developed by the aviation world to help pilots ensure basics weren’t forgotten, to reduce complexity, and foster teamwork. The Safe Childbirth Checklist we’re testing in Uttar Pradesh aims to achieve the same goal. It’s a user-friendly distillation of best practices such as handwashing, taking the woman’s blood pressure, and having all your critical life-saving materials available at the bedside including key medications, a sterile blade, a suction bulb—and a bag mask for resuscitation.
PSI is a partner with this project, along with India’s Ministry of Health, the state government in Uttar Pradesh, WHO, Community Empowerment Lab and Ariadne Labs, a joint center of Brigham and Women’s Hospital and Harvard School of Public Health, where Dr. Gawande is Executive Director. The Bill & Melinda Gates Foundation is funding the study.
The 120 public sector facilities are scattered in rural areas across 20 districts that deliver at least 1,000 babies per year, and have been paired and randomized either to use the checklist or not. PSI/India will help clinics adopt checklist use and manage information for the 172,800 births that need to be monitored. The study is projected to be finished in 2015.
There are more than 130 million births each year worldwide. 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. Will safe birth checklists help change the game?
Dr. Gawande, who also authored The Checklist Manifesto, has written previously about the massive benefits that checklists brought to the public sector health system in Michigan, in The New Yorker where he is also a staff writer.
We will know more about how they will do for childbirth in India in 2015, but in the meantime stay tuned to Impatient Optimists blog for more from Dr. Gawande on how checklists can help support health workers and save lives in those chaotic moments.
Oscar Abello is online editor, Impact, the Magazine of PSI.
Photo: A maternal health care worker conducting a routine checkup, in Jaipur, India. (Credit: PSI/Gurmeet Sapal)