Featured Review: What factors influence the provision of care by skilled birth attendants in low- and middle-income countries?

New Cochrane evidence synthesis highlights the many factors that influence the care provided by skilled birth attendants

In low- and middle-income countries, many mothers still die during childbirth. Women are encouraged to give birth in health facilities rather than at home so they can receive care from skilled birth attendants. A skilled birth attendant is a health worker such as a midwife, doctor, or nurse who is trained to manage a normal pregnancy and childbirth, and refer the mother and newborn when complications arise.

A team of Cochrane authors based in Norway, South Africa,and Uganda worked with Cochrane Effective Practice and Organization of Care to identify factors that can influence skilled birth attendant’s ability to provide quality maternity care. 31 qualitative studies conducted in Africa, Asia, and Latin America were included that explored the views, experiences, andbehaviours of skilled birth attendants. Participants were skilled birth attendants including doctors, midwives, nurses, auxiliary nurses and their managers. The search covered studies published before November 2016

This Cochrane evidence synthesis found that many factors influence the care that skilled birth attendants can provide to mothers during childbirth. Factors include access to training and supervision; staff numbers and workloads; salaries and living conditions; and access to well-equipped,well-organisedhealthcare facilities with water, electricity, and transport. Other factors that may play a role include the existence of teamwork and of trust, collaboration, and communication between health workers and with mothers. Skilled birth attendants reported many problems tied to these factors.

“This synthesis highlights the everyday realities of a health worker, working in sometimes difficult circumstances in a low or middle-income countrysetting,while trying to provide care for mothers and babies,” says Susan Munabi-Babigumira, the lead author of the Cochrane evidence synthesis. “More needs to be done to address the human resource and health system infrastructural challenges that prevent health workers based at health facilities in low- and middle- income country settings from providing good quality maternity care. This synthesis is also relevant for an international audience since it addresses the need to build resilient health systems to improve health outcomes. We hope the findings in this review can be used to design strategies to improve the quality of care for mothers and theirbabies,and improve health services in general.”

Tuesday, November 21, 2017