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8/7/2019 BETTER BIRTH INITIATIVES- GRANDROUND PRESENTATION
http://slidepdf.com/reader/full/better-birth-initiatives-grandround-presentation 1/30
EVIDENCE BASED MIDWIFERYPRACTICE
1.BETTER BIRTH INITIATIVES
A PRESENTATION FOR NURSES AND MIDWIVES GRANDROUND
OBS/GYNAE DEPARTMENT
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Best evidence forBest evidence forpractices duringpractices duringlabourlabour
Presentation prepared forPresentation prepared for
the Better Births Initiativethe Better Births Initiative
8/7/2019 BETTER BIRTH INITIATIVES- GRANDROUND PRESENTATION
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EvidenceEvidence- -based medicinebased medicine
(EBM) is...(EBM) is...
...the conscientious, explicit, and judicious use of current best evidence inmaking decisions about the care of individual patients.
Sackett et al, 1996
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EvidenceEvidence- -based health carebased health care
Without clinical expertise, evidencemay not be applicable to or appropriatefor an individual patient.
Without current best evidence, practicewill rapidly become out of date.
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Principle of EBMPrinciple of EBM
In healthcare, the overall objective
is to deliver interventions that:
do more good than harmdo more good than harm
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Part I:Part I:
Why do we need to useevidence in our clinicalpractice?
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Good practice forchildbirth care
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BackgroundBackground
In developing countries many womengive birth in state maternity facilities
Surveys show that women have negativeexperiences
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Best evidence versus traditionalBest evidence versus traditionalbeliefsbeliefs
Are our traditional obstetricAre our traditional obstetricpractices based on evidence of practices based on evidence of
effectiveness?effectiveness?
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Mobility duringMobility during labourlabour
Traditional belief
Bedrest bestBest evidence
Improved progress
of labour if mobile
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Different positions for birth
Different positions for birthTraditional belief
Supine position best
access for attendantSupine safest position
Best evidence
Supine -progressive
acidosis of baby, slowerprogressOther positions (lateral tilt,upright, squatting) lesspain, less vaginal trauma,improved fetal outcome
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F luids and food during labourF luids and food during labour
Traditional belief
Risk of inhalation if
general anaestheticneededKeep everyone nil permouth
Best evidence
No difference in
anaesthetic riskDehydration p
acidosis, fetal distressNil per mouth only forspecific reason
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Encourage childbirthEncourage childbirth
companionshipcompanionshipBest evidence
Better progress of labour
Fewer Caesarean sectionsLess painMore self-esteemBetter relationship withbabyMore breast-feedingLess depression
Traditional belief
Companions
discouraged± Worries about
infection± Get in the way
± Lack of privacy± Staff overworked
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Enemas in labourEnemas in labour
Traditional belief
Necessary to avoid
soilingUse routinely
Best evidence
No difference in
soiling (moreliquid)Use only if requested
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Stop shaving forStop shaving for labourlabour
Shaving
advocated:
To facilitatesuturing
To reduceinfection
Problems:Painful, embarrassing
Re-growthuncomfortableMicroabrasions causeinfectionNo benefits shownRisk of HIV transmission
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Avoid episiotomyAvoid episiotomy
Traditional belief
Clean incision easier
to repairHeals betterFewer 3° tearsUse routinely
Best evidence
More perineal trauma
More suturing neededMore complicationsUse only when absolutelynecessary
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Part II:Part II:
In troduci ng evide n cebased mater n ity care
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Changing practice
Changing practice
Obstacles to changing practice are
dauntingIf initial apprehension of staff isovercome, benefits will become self-evidentWith commitment from staff, changecan be achieved
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The Better Births InitiativeThe Better Births Initiative
This is a global initiative thatpromotes humane and evidencebased care for women duringchildbirth.
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The Better Births PrinciplesThe Better Births Principles
Humanity:Humanity: women treatedwith respect
Benefit:Benefit: care that isbased on thebest availableevidence
Commitment:Commitment: health professionalscommitted to
improving careAction:Action: effective strategies
to change currentpractice
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BBI standardsBBI standards
Use procedures that are effective andbeneficial:
Mobility during labourDifferent positions for birth
Companionship
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BBI standardsBBI standards
Stop using procedures that have nobenefit:
Supine position for birthWitholding fluids and food
Enemas
Shaving
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BBIBBI BBIBBI standardsstandards
Avoid making interventions routinewhen there is no evidence of benefit:
Routine episiotomyRoutine suction of neonates withoutmeconium exposure
Routine artificial rupture of membranes
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BBI standardsBBI standards
Identify other priority areas, and takesteps to bring about change:
Magnesium sulphate for eclampsiaOxytocin in third stage
Strategies to reduce MTCT of HIV
Steroids for preterm deliveryAntibiotics for Caesarean section
Use of the partogram
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Change is never easyChange is never easy
Moving towards Better Births will take a lot of time, energy and commitment.The Better Births Initiative provides thematerials to bring about real change for thebetter.It s up to each one of us to take up thechallenge.
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