Population Council Projects | An Observational Study of Facility Practices for Normal Labor in Egypt: The Relationship of Observed Practices to Evidence-based Medicine

PROJECT
An Observational Study of Facility Practices for Normal Labor in Egypt: The Relationship of Observed Practices to Evidence-based Medicine

Very few studies have documented facility practices for normal labor, although 85 percent of all births occurring worldwide follow normal labor practices. Understandably, most research has focused on standardizing practices for obstetric emergencies, or on improving access to providers trained to offer emergency care, in attempts to reduce maternal deaths. Yet understanding facility practices for normal labor is important. Most women who die as a result of postpartum hemorrhage (25 percent of all maternal deaths worldwide) experienced a normal labor. Neonatal morbidity and mortality can occur after normal labor. Furthermore, women are entitled to high-quality obstetric care even in the absence of life-threatening complications. The documentation of facility practices for normal labor is therefore a necessary prerequisite to improving service quality.

The Population Council completed a large study that sought to comprehensively document practices for normal labor in a busy teaching hospital in Cairo, Egypt. Using a triangulated approach, hospital policies for women in labor were documented by direct observation of 176 women in labor at a busy, centrally located maternity hospital that trains over 200 young doctors annually. Data were collected quantitatively and qualitatively by directly observing women for their entire labor and delivery, documenting ward activities, and interviewing women who had delivered their babies.

Many observed practices diverged from evidence-based medicine. Significant among these are poor assessment upon arrival, poor provider–patient communication, overuse of oxytocin for augmentation of the first stage of labor, and inappropriate management of the third stage of labor (which includes delivery of the placenta). These findings were presented at several workshops. The research team has collaborated with researchers based at several institutions to move forward with research on this topic in the Middle East.

Location

El Galaa Teaching Hospital, Cairo, Egypt

Duration

2001–July 2002

Population Council researcher

Miral Breebaart

Non-Council collaborators

Mohamed Cherine, consultant (El Galaa Teaching Hospital)

Nevine Hassanein, consultant (John Snow Inc.)

Amr Elnoury (National Laser Institute, Cairo University)

Donors

American University in Cairo