Encouraging ob/gyns to apply practice guidelines

A multifaceted behavioral intervention to encourage adherence to obstetric 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, MD, 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% at baseline to 83.6% in hospitals participating in the intervention, compared to an increase from 2.6% to 12.3% at control hospitals, the researchers report. Episiotomy rates decreased from 41.1% to 29.9% at intervention hospitals, but remained constant at 43.5% to 44.5% 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.”

Althabe F, Buekens P, Bergel E, et al. A behavioral intervention to improve obstetrical care. N Engl J Med. 2008;358:1929-1940.