Monday, September 12, 2016

Discussing the New WHO Standards for Improving Quality of Maternal and Newborn Care in Health Facilities - Trying to Address the Flaws in the System

In a welcome response to the stagnate reduction in maternal/infant morbidity/mortality as well as a response to the quality of care that contributes to maternal/infant morbidity/mortality, the World Health Organization has created the new global document, "Standards for Improving Quality of Maternal and Newborn Care in Health Facilities".

This document centers around eight standards that the WHO feels should be implemented, monitored and improved based on the health care system in which it is adopted.  Not unlike the Healthy People 2010 and 2020
standards, the WHO standards define exactly what is needed to obtain high quality care during the childbirth experience.  Each standard is followed by a series Quality Statements that further define what researchers are looking for in the standard.  

While the use of the word "routine" is seen several times, it is the desire of the WHO Standards writers that evidence-based care become routine and not be the exception.  In far too many facilities world wide, evidence-based care is not practiced.  Traditional practices, perhaps years old, are the rule and not to be questioned.  This is a matter of culture and understanding.  In more industrialized nations, the use of evidence-based care has been slow to be embraced in part due to the political bureaucracy of the hospital system.  Creating, researching, reviewing, approving, and implementing new policies, procedures and practice guidelines takes time. Unfortunately, time is something that those in management positions rarely has and so the old adage, "if it ain't broke, don't fix it" becomes an unspoken mantra.  Again, unfortunately, many policies, procedures and practice guidelines do need to be updated or even recreated to ensure evidence-based care.  This is where there is a flaw in the system.

Below is a list of the Standards.

Standard 1. Every woman and newborn receives routine, evidence-based care and management of complications during labour, childbirth and the early postnatal period, according to WHO Guidelines. 

Standard 2. The health information system enables use of data to ensure early and appropriate action to improve the care of every woman and newborn.

Standard 3. Every woman and newborn with condition(s) that cannot be dealt with effectively with the available resources is appropriately referred.

Standard 4. Communication with women and their families is effective and responds to their needs and preferences.

Standard 5. Women and newborns receive care with respect and preservation of their dignity.

Standard 6. Every woman and her family are provided with emotional support that is sensitive to their needs and strengthens the woman's capability.

Standard 7. For every woman and newborn, competent, motivated staff are consistently available to provide routine care and manage complications.

Standard 8. The health facility has an appropriate physical environment, with adequate water, sanitation and energy supplies, medicines, supplies and equipment for routine maternal and newborn care and management of complications.

These standards, as do the Healthy People 2020 Initiative, help to develop a proper framework, set of definitions and standards of care.  These standards have not been created by chance, but by a comprehensive set of research standards assessing the global issue of maternal/infant morbidity/mortality.  Resources for research of the standards included The Joint Commission (US), the National Institute for Health and Care Excellence (NICE) UK, the Council for Health Service Accreditation of Southern Africa, and the Australian Commission on Safety and Quality in Health Care (2012).

Each standard carried the same characteristics of the care being safe, effective, timely, efficient, equitable and people-centered.  This is of particular interest to childbirth educator and doulas who, as part of their role today, act as guardians of labor support and informed consent.  For expectant families to truly understand if these eight standards are being implemented by their hospital or facility, education becomes the key.  Standard 4 discusses at length the importance of effective communication - communication cannot be effective if both sides of the conversation are not speaking the same language.  By same language, I don't imply English or French.  I am talking about the knowledge of labor and birth, effective and evidence-based care, and listening to the mother's preference.  When preferences cannot be granted due to medical complications, appropriate care and information must be given that is respectful and preserves dignity.

Standard 6 is nearly a mandate for birth doula care.  What else can I say?  The research for the last 30+ years screams the benefits of doula care for the expectant/laboring/postpartum mother!  Why oh why are we embrace that which improves outcomes and patient satisfaction?  What is the medical community afraid of?  Yes, afraid?  Is it financial?  My feeling has always been that if a hospital had a doula program, they could market that in an incredible way and become the hero of the community based on maternal satisfaction alone.  And we all know who drives the medical referral bus in families - yes, mothers.  It is one of those magical moments that hospitals are missing.

To read more and get your FREE copy of the WHO Standards of Care, click here.

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