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Behavioral Intervention Improves Obstetric Care

Hospitals participating in intervention had measurable improvements in guideline adherence

WEDNESDAY, April 30 (HealthDay News) -- A multifaceted behavioral intervention to encourage adherence to obstetrical guidelines resulted in increased use of prophylactic oxytocin during the third stage of labor and decreased rates of episiotomy, according to an article published in the May 1 issue of the New England Journal of Medicine.

Fernando Althabe, M.D., of the Institute of Clinical Effectiveness and Health Policy in Buenos Aires, Argentina, and colleagues randomly assigned 19 hospitals in Argentina and Uruguay to participate in a multifaceted behavioral intervention to implement guidelines for the use of episiotomy and management of the third stage of labor, or to receive no intervention. The intervention involved selection of opinion leaders, interactive workshops, one-on-one visits with hospital birth attendants, reminders and feedback. The primary outcomes studied were rates of episiotomy and prophylactic use of oxytocin during the third stage of labor.

Following the 18-month intervention, the use of prophylactic oxytocin increased from 2.1 percent at baseline to 83.6 percent in hospitals participating in the intervention, compared to an increase from 2.6 percent to 12.3 percent at control hospitals, the researchers report. Episiotomy rates decreased from 41.1 percent to 29.9 percent at intervention hospitals, but remained constant at 43.5 to 44.5 percent at control hospitals.

The authors conclude that these results "highlight the effectiveness of active versus passive dissemination of information in changing the behavior of birth attendants."

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