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More than words: childbirth training change improves safety, cuts unnecessary procedures
Date:4/30/2008

CHAPEL HILL Relatively inexpensive interventions were effective in helping health care providers in Latin America improve the way they treat mothers during labor and delivery, reducing bleeding and sometimes saving lives of women during childbirth, according to a University of North Carolina at Chapel Hill School of Public Health study released today in the New England Journal of Medicine.

Using teaching techniques that employed behavioral change strategies aimed at modifying practices, researchers were able to reduce the number and severity of episiotomies, a surgical procedure in which a doctor or midwife makes an incision in the tissue between the mothers vagina and rectum during childbirth.

They were also able to increase the use of the hormone oxytocin which is given to mothers to make their uterus shrink and bleed less to manage the third stage of labor, when the placenta detaches and passes from the uterus and hemorrhaging may occur.

At the start of the study, public hospitals in Argentina and Uruguay had very high rates of routine episiotomy and low rates of actively managing the third stage of labor. In the randomized trial of 20 hospitals, 10 received the intervention and the rest received clinical practice guidelines via seminars.

The intervention included identifying and training small teams of respected medical opinion leaders at several hospitals. These teams then trained their peers, and provided their colleagues with ongoing reminders and feedback regarding progress.

Researchers found that these evidence-based behavioral approaches proved to be far more effective than knowledge alone in getting public hospital physicians and midwives to adopt clinical practice guidelines that can save lives.

The results showed that just receiving the information had little effect on practice. Oxytocin use increased from 2.1 percent before the study began to 83.6 percent after the end of the interventio
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Contact: Patric Lane
patric_lane@unc.edu
919-962-8596
University of North Carolina at Chapel Hill
Source:Eurekalert

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