Status Of Intrapartum Service On Evidence-based Practice In Pudong Maternal And Child Health Hospital

Intrapartum service is directly related to the safe of the pregnant women. Evidence-based medicine emphasizes that all the clinical decisions should be based on the best evidence available, combine the physician’s clinical expertise with the patient’s values to ensure the patients get the best treatment and have higher life quality. Evidence-based service improve the service quality of intrapartum care, avoid or reduce the unnecessary damage to maternal and child health which brought by ineffective or even harmful treatments. Now many scientific evidence has been easy to access in intrapartum service practices, but the evidence is not used widely. There is still a gap between clinical practices and evidence in childbirth care.Objectives:This study was designed to understand the current use of intrapartum intervention in Pudong Maternal and Child Health Hospital. In this study we want to know the medical staff’s views and the maternal perception to intrapartum services and whether the practices had changed in nearly years. This paper also describes what the current intrapartum service practice is and what caused the changes in practicing in order to give suggestions for changing current practices.Subjects and Methods:The study was conducted in Pudong Maternal and Child Health Hospital which has more than 11,000 childbirth every year. We chose the service providers worked and postpartum women delivered in the hospital as subjects. The contents of the study include current intrapartum intervention in childbirth care, providers’and maternal perception on intrapartum services, changing practices and the influencing factors.809 postpartum women were interviewed consecutively in January-February 2013. We used a semi-structured interview to explore women’s and service provider’s views on intrapartum service by in-depth interview.8 service providers and 8 women were interviewed.Results and Conclusions:(1) During vaginal delivery, enemas and rectal examination which were recommended to be avoided as routine by World Health Organization(WHO) are no longer used, and perineal shaving which should also be repealed are still carried out in some pregnant women just before perineal cutting. There had different condition in the use rate of procedures which should be encouraged. Accompany childbirth had increased, pregnant women are encouraged to move in different positions before they enter the labor room, but free position in childbirth and non-pharmacological analgesic were not carried out effectively. Furthermore, there was an increasing trend in the use of electronic fetal monitoring which should be restricted. Episiotomy rate was still high (86.67%), but some midwives were trying selective episiotomy.(2) Most of women interviewed asked for companionship during their childbirth, but in fact the companionship rate was far smaller. The qualitative results shows that the usage of companied delivery is restricted by hardware facilities, medical expenses and the shortage of doula resources and other factors. More family-oriented ward should be provided for families to enter and accompany, and the cost should be reduced. The Government should provide subsidies to ensure that mothers have access to this service. We urged the society to cultivate a group of professional doula team to relieve the stress of the midwifery staff.(3) Similar to the majority hospitals, free body position in labor has not carry out effectively. It’s influenced by hospital policies, hardware conditions, inadequate education and training. From the qualitative results, many obstetric staff cannot grasp on the free body position in labor and they have many unnecessary fears. Pregnant women know less about it, so they cannot do informed choice or act in concert. The advantages and disadvantages of different delivery position should be researched to find out the most suitable delivery position to different woman.(4) Quantitative studies have shown that the frist reason of pregnant women required cesarean section (CS) is the fear of pain. Women would most like to reduce pain during childbirth in all the maternity services provided by the hospital. But now there are difficulties in extensive pharmacological analgesia, and non-pharmacological analgesia has not carried out systematically and effectively. Maternal knowledge of non-pharmacological analgesia is not enough, routine episiotomy for primipara is widespread. In order to promote natural birth, make it more comfortable and reduce the requested CS rate, prenatal health education about labor analgesia and restrictive episiotomy should be given to both women and health provider. Changing the traditional midwifery teaching content, practice midwifery skill may continuously reduce the episiotomy rate.(5) Generally speaking, women were satisfied with the obstetric services they received during their stay in hospital. They were also satisfied with the attitude and service provided by doctors and nurses. They want to receive more high-quality delivery service. Such as relieve labor pain, avoid episiotomy, receive companionship, deliver in different positions and have more single room. Some women suggested the hospital to increase the number of medical staff, provide a more comfortable environment and provide postpartum meals. The hospitals should fully consider the reasonable requirements of maternal and make intrapartum service more humane.(6) In the recent ten years, the main changes of the intrapartum service in the hospital is that the enema and rectal examination had been canceled and routine shave on admission had been stopped. Women can receive companionship, deliver in single room, receive pharmacological analgesia in the hospital. There are more fetal heart monitoring equipment and more skilled medical staff. The proportion of cesarean section is decreasing.(7) The qualitative results shows that obstetrical policy and continuing medical education promoted the evidence into obstetrical practice. But the use of evidence was also influenced by the factors such as routine guidelines, hospital managers’opinion, awareness of best evidence, skills of service providers, and other factors such as human resources and the limited space of the hospital.