Objectives: To document facility-based practices for normal labour and
delivery in Egypt, Lebanon, the West Bank (part of the Occupied
Palestinian Territory) and Syria and to categorise common findings
according to evidence-based obstetrics. Design: Three studies (Lebanon,
West Bank and Syria) interviewed a key informant (providers) in
maternity facilities. The study in Egypt directly observed individual
Setting: Maternity wards. Sample: Nationally representative sample of
hospitals drawn in Lebanon and Syria. In the West Bank, a convenience
sample of hospitals was used. In Egypt, the largest teaching hospital's
maternity ward was observed.
Methods: Shared practices were categorised by adapting the World Health
Organization's (WHO) 2004 classification of practices for normal birth
into the following: practices known to be beneficial, practices likely
to be beneficial, practices unlikely to be beneficial and practices
likely to be ineffective or harmful. Main outcome measures: Routine
hospital practices for normal labour and delivery.
Results: There was infrequent use of beneficial practices that should be
encouraged and an unexpectedly high level of harmful practices that
should be eliminated. Some beneficial practices were applied
inappropriately and practices of unproven benefit were also documented.
Some documented childbirth practices are potentially harmful to mothers
and their babies. Conclusion: Facility practices for normal labour were
largely not in accordance with the WHO evidence-based classification of
practices for normal birth. The findings are worrying given the
increasing proportion of facility-based births in the region and the
improved but relatively high maternal and neonatal mortality ratios in
these countries. Obstacles to following evidence-based protocols for
normal labour require examination.
Kabakian-Khasholian, T. Routines in facility-based maternity care: evidence from the Arab World. BJOG: An International Journal of Obstetrics and Gynaecology (2005) 112 (9) 1270-1276. [DOI: 10.1111/j.1471-0528.2005.00710.x]
Routines in facility-based maternity care: evidence from the Arab World.