Learning Before Leaping: Integration of an Adaptive Study Design Process Prior to Initiation of BetterBirth

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Adaptive trial designs are used in quality improvement  interventions to provide the strongest evidence for effective implementation and impact of a program prior to scale-up.

We previously showed that BetterBirth, an on-site coaching intervention focused on the World Health Organization Safe Childbirth Checklist, improved performance of essential birth practices in one facility in Karnataka, India. Here, we describe how we modified and strengthened the intervention and then implemented it in three additional facilities. This work was critical to develop a replicable BetterBirth package tailored to the local context.

The multi-center trial is now underway, measuring the impact of the BetterBirth program on essential birth practices and maternal-neonatal morbidity and mortality.