Strengthening evidence-based intrapartum and newborn care practices in medical schools: Subnational implementation research from India.

OBJECTIVE

We examined the impact of a codesigned multicomponent implementation strategy on adherence to evidence-based intrapartum care, respectful maternity care, and newborn care practices in 11 medical schools across two states and a union territory in India.

METHODS

We conducted pre-post implementation research using the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework from July 2019 to October 2021. The implementation strategy was codesigned by researchers and medical school faculty. At baseline and endline, we recruited intranatal (n = 175, 158) and postnatal women (n = 158, 167) with uncomplicated vaginal delivery for observation and interview, respectively. The primary outcome was proportion of uncomplicated deliveries with a composite of avoiding augmentation, avoiding episiotomy, and using alternate birthing positions. We used generalized estimating equations to compare baseline and endline findings and estimated adjusted prevalence odds ratios (APORs).

RESULTS

The primary outcome increased from 5.4% at baseline to 17.4% at endline with APOR 3.55 (95% CI: 1.08, 11.66). A decline was observed in not-recommended practices, namely pubic shaving (APOR 0.05, 95% CI: 0.01, 0.18), enema (APOR 0.07, 95% CI: 0.02, 0.22), fundal pressure (APOR 0.05, 95% CI: 0.02, 0.14), episiotomy (APOR 0.75, 95% CI: 0.38, 1.48). Newborn care practices showed the greatest improvements in early initiation of breastfeeding (APOR 42.35, 95% CI: 5.70, 314.61) and delayed cord clamping (APOR 21.28, 95% CI: 6.00, 75.43). Results from postnatal interviews corroborated those from direct observation in the labor room.

CONCLUSION

A codesigned multi-component implementation strategy can improve adherence to evidence-based intrapartum and newborn care practices in medical schools.