Translating evidence into practice in childbirth: A case from the Occupied Palestinian Territory

Objective: To investigate possible changes in practices during normal childbirth by implementing interventions which reduce the frequency of: intravenous fluids; bladder catheterization; analgesia; artificial rupture of membranes; oxytocin use for augmentation; vaginal examination; episiotomy, and increase: mobility; oral intake of fluids; and initiation of immediate breastfeeding. Design: An operational research design. Setting: A referral governmental hospital in the Occupied Palestinian Territory (oPt) between 2006 and 2010. Participants: 2345 women (baseline: 134 women, intervention: 1860 women, post-intervention: 351 women) and 17 providers (10 midwives and 7 physicians). Interventions: Multifaceted interventions; a combination of on-the-job training, audit, and feedback, supported by a core team and informal meetings. Main outcome measures: Change of practices during normal childbirth according to best evidence and the WHO recommendations. Findings: Significant sustained improvements in practices during childbirth from baseline to post-intervention including artificial rupture of membranes, liberal use of oxytocin to augment normal labour, intravenous fluids, frequency of vaginal examinations, oral intake, immediate breastfeeding and routine episiotomy (P < 0.005). There was positive change in the mobility during labour, but this change was not sustained after 9 months from intervention to post-intervention. The usage of analgesia did not change. Key conclusions: Certain changes in practices during normal childbirth were possible in this hospital. A combination of on-the-job training with other interactive approaches increased midwives' awareness, capacities and self-confidence to implement fewer interventions during normal labour. (C) 2012 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.