Use of Evidence-Based Practices in Pregnancy and Childbirth: South East Asia Optimizing Reproductive and Child Health in Developing Countries Project

Subject: Mother and Child Health Nursing
Name: Shaira May B. Luzadas
Topic: Reflection on Evidence-Based Practice for Pregnancy
Name of Instructor: Dr. Maricel Nasog
Date of Submission: August 6, 2019
Use of Evidence-Based Practices in Pregnancy and Childbirth: South East Asia Optimizing
Reproductive and Child Health in Developing Countries Project
Summary:
This study describes the rates of use of selected practices of key aspects of perinatal care
reported in the medical records of nine hospitals in Indonesia, Malaysia, Philippines and
Thailand. The findings show high rates of compliance for some of Evidence-based
recommendations for perinatal care and wide divergence for others. Practices that were in line
with recommendations across most hospitals for the beneficial forms of care were controlled
cord traction, one of the components of the active management of the third stage of labor and
treating eclampsia with magnesium sulphate. The unnecessary practice of enema use was
appropriately widely avoided. The highest level of divergence from best practice
recommendations in most countries was not administering appropriate antibiotic prophylaxis for
caesarean section. Liberal use of episiotomy for women having a vaginal birth is not
recommended but was often inappropriately practiced across the hospitals in all four countries,
demonstrating lack of adoption of the evidence-based recommendation of restrictive episiotomy.
Other forms of perinatal care such as pubic hair shaving and the use of enemas during labour
varied in rates of compliance across all countries and even between hospitals within the same
country.
The principles of evidence-based practice are to encourage health professionals to use
practices with proven benefit and eliminate the use of those shown to be ineffective or harmful.
Effective implementation of beneficial practices in developing regions, such as South East Asia,
should lead to a reduction in maternal and neonatal mortality and morbidities.
Our findings are consistent with three previous reports of perinatal practice from the
Asian and Arab world. The first was reported by the Choices and Challenges in Changing
Childbirth Research Network. The network documented routine obstetric practices for normal
labour and birth in Egypt, Lebanon, Syria and the West Bank, and compared these with
evidence-based recommendations. They showed the practices for normal labour were largely not
in accordance with the World Health Organization evidence-based classification of practices for
normal birth. The second report described facility-based practices for normal labour and birth.
Forty-four clinical practices observed in a busy Egyptian teaching hospital were categorised
according to World Health Organization Technical Working Group on normal birth classification
of normal birth practices. This study concluded that practices for normal labour were largely not
consistent with the World Health Organization evidence-based classification of practices for
normal births. The third report compared practices of selected childbirth care procedures against
evidence-based information and explored user and provider views about each procedure in four
hospitals in Shanghai, China. They concluded that obstetric practices of the hospitals studied
were not following best available evidence.

There is clear evidence of benefit to perinatal health outcomes with use of appropriate
antibiotic prophylaxis for caesarean section, use of antenatal corticosteroids for women at risk of
preterm birth and family support during labour. Our findings however, show that these clinical
practices were rarely performed in most of the included hospitals, with high rates of variation
across the countries. It is likely that there are a range of barriers to all these clinical practices in
our study settings, but detailed exploration of these was outside the scope of this initial audit.
Although we were not able to interview the care providers or directly observe the clinical
practices at the time of this survey, these were planned for a later stage of this project.
Reaction:
The burden of mortality and morbidity related to pregnancy and childbirth remains
concentrated in developing countries. This disparity continues with rates of neonatal mortality
almost 10 times greater in South East Asia than developed regions. An evidence-based care and
knowledge implementation improves adoption of best clinical practice recommendations leading
to better health for mothers and babies. Now is the time for us, especially who are part of the
health care team concerning the mother and their babies to end their suffering and decrease the
mortality and morbidity related to pregnancy and childbirth by researching an evidence-based
practice to apply in all hospitals as a protocol in order to save the lives of the mother and babies.
Perinatal care should be improved especially in South East Asian countries, one way is the
recording of clinical practices which is essential in improving the quality health of care. Keep in
mind that they should be properly nurtured and cared before, during and after birth. It is not just
the unnecessary C-sections and labor induction which contributes to the mortality but there are
also factors that could lead to mortality just like, access to prenatal care, use of tobacco, alcohol
and other substances during pregnancy, birth defects, infections like cytomegalovirus, maternal
medical conditions that affect pregnancy like diabetes, obesity, and hypertension, premature birth
and low birthweight babies, breastfeeding, infant mortality, including infant sleep-related death,
Shaken Baby Syndrome sometimes call abusive head trauma and perinatal depression.
To improve perinatal health, we need the right tools to assess problems and their causes.
We also need to monitor the impact of policy initiatives over time.

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Use of Evidence-Based Practices in Pregnancy and Childbirth: South East Asia Optimizing Reproductive and Child Health in Developing Countries Project

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Subject: Mother and Child Health Nursing

Name: Shaira May B. Luzadas

Topic: Reflection on Evidence-Based Practice for Pregnancy

Name of Instructor: Dr. Maricel Nasog

Date of Submission: August 6, 2019

Reproductive and Child Health in Developing Countries Project

The principles of evidence-based practice are to encourage health professionals to use

should lead to a reduction in maternal and neonatal mortality and morbidities.

were not following best available evidence.

knowledge implementation improves adoption of best clinical practice recommendations leading

mortality and morbidity related to pregnancy and childbirth by researching an evidence-based

We also need to monitor the impact of policy initiatives over time.

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