Student Dissertation

Agency : Intra-Partum Care; Labour Room; Newborn Care; Quality of Care

Objective : To assess the quality of intra-partum care provided 2. To assess the quality of essential new-born care provided

Background : Most of the maternal mortality (44%) is centred around the delivery of the baby, in the intra-partum and immediate post-partum period (16% intra-partum period and 28% on the birth day). Similarly, 40% of neonatal mortality and stillbirths happen during the same period (21% intra-partum and 19% birthday). This is the period of highest risk for mortality for both mothers and new-borns. During this period, the woman is usually at a health facility if she has chosen to deliver at an institution. These deaths could be averted if prompt care is given with quality. The rates of institutional births increased since the advent of National Health Mission and Janani Suraksha Yojana, whereas, reduction in maternal and neonatal mortality is not proportional with increase in institutional births. Hence, quality of care for intra and immediate postpartum period (care in labour rooms) at institutions needs improvement. The District Hospital in Shahdol is the highest referral facility in Shahdol district. It is the only functional L3 delivery point in the district which gets referrals from 33 other public delivery points spread across the district. The average normal deliveries that are conducted in the hospital is 400 per month. Compromising on the quality of care provided at the labour room can result in compromised health of the mother and the new-born. This could result in their mortality and morbidity that could have been prevented. As no studies, have been done in Shahdol to assess the quality of intra-partum and essential new-born care provided, the results of this study will provide information on the gaps in providing care and the reasons for the same. It will help in planning strategies to provide improved care in the labour room.

Methodology : Study area: Madhya Pradesh Study period: April 2016 Study setting: District Hospital, Shahdol Study population: Women delivering at District Hospital, Shahdol Data: ï‚· Quantitative – Occurrence of different parameters during labour ï‚· Qualitative – Key informant interviews with the staff nurses of the labour room Inclusion criteria: Deliveries of all the women who come to the labour room in the active phase of labour were observed Exclusion criteria: ï‚· Simultaneous deliveries being conducted at the same time Delivery of babies who died intra uterine Sampling: 60 deliveries were observed from the admission of the woman to the labour room till discharge. The average number of deliveries in a month at the district hospital is 400 per month. 30% of the deliveries were observed during the period in consideration (2 weeks).

Findings : Even though the resources were available for conducting PV examination as per indicated, none followed the hand hygiene protocols and just 30% wore gloves on both hands with correct technique. Only 26.7% deliveries had the partograph plotted and 13.3% conducted six cleans. The steps of third stage of labour were followed satisfactorily except checking the placenta which only 48.3% did. During 40% of the deliveries, breastfeeding counselling was given.

Recommendations : The quality of care has been majorly compromised on the infection prevention front. Quality of care with respect to the preparation to receive the new-born was grossly deficient. Reasons for not giving quality care in the labour room can be summed up in three points from the KII: 1. Lack of human resource 2. Huge patient load 3. Not enough time to give each patient Posting more staff nurses and housekeeping staff in the labour room Strictly enforcing the infection prevention protocols Strictly enforcing use of partographs to monitor the progress of labour and not to fill it post-delivery to maintain records


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