Evidence-based intrapartum care in Cali, Colombia: a quantitative and qualitative study.

OBJECTIVES

To measure the rate of use of selected intrapartum obstetric practices and to explore the factors associated with their use.

DESIGN

Prospective quantitative and qualitative study.

SETTING

Fifteen public and private hospitals in Cali, Colombia.

SAMPLE: Quantitative arm: 1,767 low-risk women delivering a single live baby; qualitative arm: 36 intrapartum care providers.

METHODS

Quantitative analysis of women's clinical charts for measuring the rates of obstetric practices. Qualitative analysis of audiotaped semi-structured interviews with intrapartum care providers.

MAIN OUTCOME MEASURES: Rates of use of ten intrapartum obstetric practices and associated factors and intrapartum care providers' views on evidence-based obstetric practice.

RESULTS

Rates for the ineffective practices of enema use, perineal/pubic shaving, and routine intravenous infusion during labour were around 75%. Episiotomy rates for primiparae and multiparae were 70 and 22%, respectively. Rates for the beneficial practices of active management of the third stage of labour and allowing women's choice of position during the first stage of labour were around 45%. Companionship during labour, external cephalic version for breech presentation at term, and absorbable synthetic sutures for episiotomy showed rates of utilisation lower than 15%. Hospital characteristics, type of intrapartum care provider, and women's medical insurance status were associated with use of selected practices. Barriers and opportunities for implementing evidence-based practices in routine obstetric care were identified.

CONCLUSIONS

Intrapartum care in Cali, Colombia, is not guided by the best available evidence. Effective change strategies should be undertaken to encourage the adoption of obstetric practices clearly demonstrated as effective and to discard those that are ineffective.