Impact of a low-technology simulation-based obstetric and newborn care training scheme on non-emergency delivery practices in Guatemala

• Published in: International journal of gynecology and obstetrics 2016-03, Vol.132 (3), p.359-364
• Main Authors: Walton, Anna, Kestler, Edgar, Dettinger, Julia C, Zelek, Sarah, Holme, Francesca, Walker, Dilys
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Cross-Sectional Studies; Delivery, Obstetric - education; Education and Training; Emergency obstetric and newborn care; Evidence-Based Practice - standards; Female; Guatemala; Humans; Infant; Infant Mortality; Infant, Newborn; Maternal Mortality; Midwifery - education; Neonatal mortality; Obstetrics and Gynecology; Patient-Centered Care - standards; Pregnancy; Skilled birth attendants; Training; Young Adult
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2015.08.009

Abstract Objective To assess the effect of a low-technology simulation-based training scheme for obstetric and perinatal emergency management (PRONTO; Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) on non-emergency delivery practices at primary level clinics in Guatemala. Methods A paired cross-sectional birth observation study was conducted with a convenience sample of 18 clinics (nine pairs of intervention and control clinics) from June 28 to August 7, 2013. Outcomes included implementation of practices known to decrease maternal and/or neonatal mortality and improve patient care. Results Overall, 25 and 17 births occurred in intervention and control clinics, respectively. Active management of the third stage of labor was appropriately performed by 20 (83%) of 24 intervention teams versus 7 (50%) of 14 control teams ( P = 0.015). Intervention teams implemented more practices to decrease neonatal mortality than did control teams ( P < 0.001). Intervention teams ensured patient privacy in 23 (92%) of 25 births versus 11 (65%) of 17 births for control teams ( P = 0.014). All 15 applicable intervention teams kept patients informed versus 6 (55%) of 11 control teams ( P = 0.001). Differences were also noted in teamwork; in particular, skill-based tools were used more often at intervention sites than control sites ( P = 0.012). Conclusion Use of PRONTO enhanced non-emergency delivery care by increasing evidence-based practice, patient-centered care, and teamwork.