Training Reduces Pregnancy Complications
Reported May 05, 2008
(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 Healths 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
