Quality of labor and birth care in Sindh Province, Pakistan: Findings from direct observations at health facilities

Autoři: Sohail Agha aff001;  Laura Fitzgerald aff002;  Aslam Fareed aff003;  Presha Rajbhandari aff002;  Shaista Rahim aff004;  Farhana Shahid aff005;  Emma Williams aff002;  Wajiha Javed aff005;  Sheena Currie aff002
Působiště autorů: The Bill and Melinda Gates Foundation, Seattle, Washington, United States of America aff001;  Jhpiego, Baltimore, Maryland, United States of America aff002;  The Indus Hospital, Karachi, Pakistan aff003;  Murshid Hospital, Karachi, Pakistan aff004;  Jhpiego, Karachi, Pakistan aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0223701


This study presents data from the first observation of labor, childbirth and immediate newborn care in a clinical setting in Sindh, the second most populous province of Pakistan. Trained midwives observed 310 births at 126 district level referral facilities and primary health care facilities in 10 districts of Sindh where the USAID-funded Maternal Child Health Integrated Program (MCHIP) was implemented. The facility participation rate was 78%. The findings show that monitoring vital signs during the initial examination was conducted for less than one-in-ten women. Infection prevention practices were only observed for one-in-four women. Modesty was preserved for less than half of women. In spite of an absence of monitoring during the first and second stages of labor, providers augmented labor with oxytocin in two-thirds of births. To prevent post-partum hemorrhage, oxytocin was administered within a minute of birth in 51% of cases. Immediate drying of the baby was nearly universal and eight out of ten babies were wrapped in a dry towel. Newborn vital signs and the baby’s weight were taken in one-in-ten cases. Breastfeeding was initiated during the first hour of birth in 18% of cases. A support-person was present during labor and birth for 90% of women. While quality of care is poor across all facilities, the provision of care at district-level referral facilities was even lower quality than at primary health care facilities. This is because dais or assistants without formal training provided labor, birth, and newborn care for 40% of deliveries during night shifts at referral facilities. This study found many examples of suboptimal practice by skilled birth attendants across all levels of health facilities. There remains an urgent need to improve quality of service provision among skilled birth attendants in Pakistan.

Klíčová slova:

Birth – Health care facilities – Labor and delivery – Midwives – Neonatal care – Neonates – Pakistan – Quality of care


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