(Ivanhoe Newswire) -- It can be difficult to get doctors to change what
they are used to doing, but new research says it can be done.
Study authors say an intensive educational program for physicians and midwives
in Argentina and Uruguay dramatically reduced incidences of postpartum
hemorrhage. Postpartum hemorrhage is excessive bleeding by the mother after she
gives birth.
To do the study, researchers identified the top opinion leaders at 10 public
hospitals in Argentina and Uruguay. Three to six of the opinion leaders were
selected from each hospital and attended a five day workshop on how to develop
and carry out guidelines for physicians and midwives based on the best
scientific evidence available. Specifically, the leaders were shown the
guidelines for use of the drug oxytocin to prevent postpartum hemorrhage in
women just after a vaginal birth. They were also educated about the downside of
episiotomy -- an incision in the skin between the vagina and anus. Episiotomies
were thought to prevent tearing, but now are considered not beneficial.
Nine other hospitals served as controls for the study because their leaders did
not attend the workshop. Researchers say after 18 months, the use of oxytocin
increased 80 percent in the hospitals with the leaders who attended the workshop
compared to 10 percent in the other hospitals. Postpartum hemorrhage also
decreased by 45 to 70 percent in those hospitals where staff received
instruction. The number of episiotomies also decreased in the hospitals with the
leaders who were at the workshop and increased at the other hospitals.
“It can be difficult to change accepted medical practices,” says Duane
Alexander, M.D., director of the National Institute of Health’s Eunice Kennedy
Shriver National Institute of Child Health and Human Development. “This
successful intervention offers an effective model that can be translated into
education programs suitable for interventions throughout the United States and
Latin America.”
SOURCE: New England Journal of Medicine, 2008;358:1929-1940
