BackgroundAlthough there are many evidence-based practices that reduce the risk of maternal and neonatal mortality around the time of birth, there remains a gap between what is known and the care received. This know-do gap is a source of preventable maternal and perinatal deaths and is the focus of improvement efforts in many countries. Following an increase in perinatal and maternal deaths, Gobabis District Hospital initiated a quality improvement (QI) initiative to increase adherence to these WHO Safe Childbirth Checklist (SCC)-targeted essential birth practices (EBPs).MethodsWe implemented the SCC with support from leadership, coaching and organisational redesign. Implementation was led by a facility champion supported by a QI team and adapted through a series of three 8-week Plan–Do–Study–Act (PDSA) cycles.ResultsDuring the 6-month period, we observed an improvement of average EBPs delivered from 68% to 95%. We also found reductions in perinatal mortality rates from 22 deaths/1000 deliveries to 13.8/1000 deliveries largely due to a drop in fresh stillbirths.ConclusionWe conclude that replicating the programme is feasible, acceptable and effective in areas where gaps exist, but it requires local leadership, ongoing coaching and adaptation through PDSA cycles.

(JAMA 2015;314(21):2263–2270) Cesarean deliveries can be lifesaving for women with obstructed labor and other emergency conditions. As per the World Health Organization (WHO) recommendation, cesarean delivery rates should not exceed 10% to 15% of deliveries. However, actual rates are higher in many countries. The aim of this study was to provide better estimates of the contemporary relationship between national cesarean delivery rates and neonatal and maternal mortality.

(N Engl J Med. 2017;377(24):2313–2324) The Safe Childbirth Checklist, created by the World Health Organization, is a practical tool encompassing a bundle of 28 essential birth practices. In the present study, the authors performed a large cluster-randomized trial of the BetterBirth program, which involves a coaching-based implementation of this checklist, to determine whether or not facility-based birth adherence to this checklist improved evidence-based care. The authors hypothesized that, if implemented at the cluster level, the intervention would reduce the composite outcome of stillbirth, early neonatal death, maternal death, or maternal severe complications during postpartum days 0 to 7.

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