Friday, November 11, 2011

High Hopes for Childbirth Checklist Program

What if a simple checklist could save the lives of newborn babies around the world?

In many areas of the world, childbirth is a dangerous time for both the expectant mother and the unborn baby. Each year, about 350,000 women die from childbirth complications. At the same time, close to 3 million babies die in the womb (more than a million just before delivery) and 3.1 million babies die, most near the time of birth, says MassGeneral Hospital for Children neonatologist Jonathan M. Spector, MD, MPH.

Jonathan M. Spector, MD, MPH

Jonathan M. Spector, MD, MPH

“The majority of these deaths are preventable and virtually all of them take place in low-income countries,” Spector says. “The tragedy here is that with existing knowledge and practice, those deaths are completely avoidable.”

This is where a checklist might be able to play an important role. As medicine has become more complex, simple checklists have been found to support health workers to provide high quality, safe and effective care—by providing reminders to complete essential tasks at key moments. Surgical and intensive care teams have had success using checklist-based strategies. Given the dangers of childbirth, a checklist-based program seemed worth exploring.

Helping Mothers and Babies

For the past three years, the World Health Organization (WHO) has been developing and conducting early field tests on a Safe Childbirth Checklist program for mothers and babies in resource-poor countries. The checklist program is intended for use at the time a mother is admitted to the hospital, through childbirth, to when she and her baby are discharged. Dr. Spector is now co-leading a Harvard School of Public Health study to evaluate the checklist. Atul Gawande, MD MPH, a surgeon at Brigham and Women’s Hospital who led the WHO Surgical Safety Checklist program, is also leading the study.

The WHO Safe Childbirth Checklist program has already been tested in 17 sites in countries including Kenya, Ghana and China. Dr. Spector and the Harvard team are rolling out a clinical trial, called BetterBirth, to test the checklist program in 120 hospitals in northern India.

The checklist takes aim at the major causes of death in mothers and babies. One of the biggest dangers for newborn babies is the baby’s failure to start breathing at birth.

“One in 10 babies needs help taking the first breath of life,” Spector says, a fact he sees play out in the labor rooms at MassGeneral Hospital for Children (MGHfC). The process of helping a baby breathe—resuscitation-- happens smoothly at MGHfC with the help of a team that includes a doctor, nurse and respiratory therapist. “There’s a great system in place and people have been doing it for a very long time,” he says.

“Sadly, that same streamlined process doesn’t happen in many birth centers around the world, and certainly not in those parts of the world where newborn mortality rates are the highest,” Spector adds.

Spector is hopeful the BetterBirth trial will show that the WHO Safe Childbirth Checklist program improves outcomes for mothers and babies. If it does, it will help to garner support to roll out the program in the areas that most need it around the world.

“It’s got strong promise -- the allure of such a simple tool that would be low cost to implement at scale,” Spector says. “We think it has great potential and we’re thrilled that others think that it might, as well.”

Learn more about the WHO Safe Childbirth Checklist program

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