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Modification of oxytocin use through a coaching‐based intervention based on the WHO Safe Childbirth Checklist in Uttar Pradesh, India: a secondary analysis of a cluster randomised controlled trial
Author(s) -
Marx Delaney M,
Kalita T,
Hawrusik B,
Neal BJ,
Miller K,
Ketchum R,
Molina RL,
Singh S,
Kumar V,
Semrau KEA
Publication year - 2021
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.16856
Subject(s) - medicine , childbirth , checklist , oxytocin , obstetrics , population , neonatal resuscitation , pregnancy , randomized controlled trial , emergency medicine , resuscitation , environmental health , psychology , genetics , surgery , cognitive psychology , biology
Objective To understand the prevalence of intrapartum oxytocin use, assess associated perinatal and maternal outcomes, and evaluate the impact of a WHO Safe Childbirth Checklist intervention on oxytocin use at primary‐level facilities in Uttar Pradesh, India. Design Secondary analysis of a cluster‐randomised controlled trial. Setting Thirty Primary and Community public health facilities in Uttar Pradesh, India from 2014 to 2017. Population Women admitted to a study facility for childbirth at baseline, 2, 6 or 12 months after intervention initiation. Methods The BetterBirth intervention aimed to increase adherence to the WHO Safe Childbirth Checklist. We used Rao‐Scott Chi‐square tests to compare (1) timing of oxytocin use between study arms and (2) perinatal mortality and resuscitation of infants whose mothers received intrapartum oxytocin versus who did not. Main outcome measures Intrapartum and postpartum oxytocin administration, perinatal mortality, use of neonatal bag and mask. Results We observed 5484 deliveries. At baseline, intrapartum oxytocin was administered to 78.2% of women. Two months after intervention initiation, intrapartum oxytocin (I) was administered to 32.1% of women compared with 70.6% in the control (C) ( P < 0.01); this difference diminished after the end of the intervention (I = 48.2%, C = 74.7%, P = 0.03). Partograph use remained at <1% at all facilities. Resuscitation was performed on 7.5% of infants whose mother received intrapartum oxytocin versus 2.0% who did not ( P < 0.0001). Conclusions In this setting, intrapartum oxytocin use was high despite limited maternal/fetal monitoring or caesarean capability, and was associated with increased neonatal resuscitation. The BetterBirth intervention was successful at decreasing intrapartum oxytocin use. Ongoing support is needed to sustain these practices. Tweetable abstract Coaching + WHO Safe Childbirth Checklist reduces intrapartum oxytocin use and need for newborn resuscitation.