Publication: Quality of intrapartum care by skilled birth attendants in a refugee clinic on the Thai-Myanmar border: a survey using WHO Safe Motherhood Needs Assessment
1
Issued Date
2015
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eng
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Mahidol University
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BioMed Central
Bibliographic Citation
BMC Pregnancy and Childbirth. Vol.15, (2015), 17
Suggested Citation
Gabie Hoogenboom, Thwin, May Myo, Kris Velink, Marijke Baaijens, Prakaykaew Charrunwatthana, François Nosten, Rose McGready, Mahidol University. Faculty of Tropical Medicine. Mahidol-Oxford Tropical Medicine Research Unit Quality of intrapartum care by skilled birth attendants in a refugee clinic on the Thai-Myanmar border: a survey using WHO Safe Motherhood Needs Assessment. BMC Pregnancy and Childbirth. Vol.15, (2015), 17. doi:10.1186/s12884-015-0444-0 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/3076
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Title
Quality of intrapartum care by skilled birth attendants in a refugee clinic on the Thai-Myanmar border: a survey using WHO Safe Motherhood Needs Assessment
Abstract
Background: Increasing the number of women birthing with skilled birth attendants (SBAs) as one of the strategies
to reduce maternal mortality and morbidity must be partnered with a minimum standard of care. This manuscript
describes the quality of intrapartum care provided by SBAs in Mae La camp, a low resource, protracted refugee
context on the Thai-Myanmar border.
Methods: In the obstetric department of Shoklo Malaria Research Unit (SMRU) the standardized WHO Safe
Motherhood Needs Assessment tool was adapted to the setting and used: to assess the facility; interview SBAs;
collect data from maternal records during a one year period (August 2007 – 2008); and observe practice during
labour and childbirth.
Results: The facility assessment recorded no ‘out of stock’ or ‘out of date’ drugs and supplies, equipment was in
operating order and necessary infrastructure e.g. a stand-by emergency car, was present. Syphilis testing was not
available. SBA interviews established that danger signs and symptoms were recognized except for sepsis and
endometritis. All SBAs acknowledged receiving theoretical and ‘hands-on’ training and regularly attended deliveries.
Scores for the essential elements of antenatal care from maternal records were high (>90%) e.g. providing
supplements, recording risk factors as well as regular and correct partogram use. Observed good clinical practice
included: presence of a support person; active management of third stage; post-partum monitoring; and immediate
and correct neonatal care. Observed incorrect practice included: improper controlled cord traction; inadequate hand
washing; an episiotomy rate in nulliparous women 49% (34/70) and low rates 30% (6/20) of newborn monitoring in
the first hours following birth. Overall observed complications during labour and birth were low with post-partum
haemorrhage being the most common in which case the SBAs followed the protocol but were slow to recognize
severity and take action.
Conclusions: In the clinic of SMRU in Mae La refugee camp, SBAs were able to comply with evidence-based
guidelines but support to improve quality of care in specific areas is required. The structure of the WHO Safe
Motherhood Needs Assessment allowed significant insights into the quality of intrapartum care particularly through
direct observation, identifying a clear pathway for quality improvement.