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Strengthen the Evidence for Maternal and Child Health Programs

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Established Evidence Results

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Below are articles that support specific interventions to advance MCH National Performance Measures (NPMs) and Standardized Measures (SMs). Most interventions contain multiple components as part of a coordinated strategy/approach.

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Displaying records 1 through 2 (2 total).

Iriye BK, Huang WH, Condon J, et al. Implementation of a laborist program and evaluation of the effect upon cesarean delivery. Am J Obstet Gynecol. 2013;209(3):251.e251-256. doi:10.1016/j.ajog.2013.06.040

Evidence Rating: Moderate Evidence

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Organizational Changes, Hospital Laborist, PROFESSIONAL_CAREGIVER, Consensus Guideline Implementation

Intervention Description: Cesarean delivery is a key performance metric with maternal health implications and significant financial impact. Our hypothesis is that the initiation of a full-time dedicated laborist staff decreases cesarean delivery.

Intervention Results: The cesarean delivery rate for no laborist care was 39.2%, for community physician laborist care was 38.7%, and for full-time laborists was 33.2%. With adjustment via logistic regression, full-time laborist presence was associated with a significant reduction in cesarean delivery when contrasted with no laborist (odds ratio, 0.73; 95% confidence interval, 0.64-0.83; P < .0001) or community laborist care (odds ratio, 0.77; 95% confidence interval, 0.67-0.87; P < .001). The community laborist model was not associated with an effect upon cesarean delivery.

Conclusion: A dedicated full-time laborist staff model is associated with lower rates of cesarean delivery. These findings may be used as part of a strategy to reduce cesarean delivery, lower maternal morbidity and mortality, and decrease health care costs.

Study Design: Retrospective cohort

Setting: 1 tertiary hospital in Nevada

Population of Focus: Nulliparous women who gave birth between October 2006 and October 2011

Data Source: Not specified

Sample Size: Total (n=6,206) Intervention (n=2,654) Modified intervention (n=1,722) Control (n=1,830)

Age Range: Not Specified

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Rouhe H, Salmela-Aro K, Toivanen R, Tokola M, Halmesmaki E, Saisto T. Obstetric outcome after intervention for severe fear of childbirth in nulliparous-randomised trial. BJOG. 2013;120(1):75-84.

Evidence Rating: Moderate Evidence

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Intensive Therapy, PATIENT_CONSUMER, Psychoeducation, HOSPITAL, Hospital Laborist

Intervention Description: To compare the numbers of vaginal deliveries and delivery satisfaction among women with fear of childbirth randomised to either psychoeducation or conventional surveillance during pregnancy.

Intervention Results: Women randomised to the intervention group more often had spontaneous vaginal delivery (SVD) than did controls (63.4% versus 47.5%, P = 0.005) and fewer caesarean sections (CSs) (22.9% versus 32.5%, P = 0.05). SVD was more frequent and CSs were less frequent among those who actually participated in intervention (n = 90) compared with controls who had been referred to consultation (n = 106) (SVD: 65.6% versus 47.2%, P = 0.014; CS: 23.3% versus 38.7%, P = 0.031). Women in intervention more often had a very positive delivery experience (36.1% versus 22.8%, P = 0.04, n = 219).

Conclusion: To decrease the number of CSs, appropriate treatment for fear of childbirth is important. This study shows positive effects of psychoeducative group therapy in nulliparous women with severe fear of childbirth in terms of fewer CSs and more satisfactory delivery experiences relative to control women with a similar severe fear of childbirth.

Study Design: RCT

Setting: 1 maternity unit

Population of Focus: Nulliparous women with a measured fear of childbirth who gave birth after enrollment at antenatal clinics between October 2007 and August 20095

Data Source: Not specified

Sample Size: Total (n=371) Intervention (n=131) Control (n=240)

Age Range: Not Specified

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The MCH Digital Library is one of six special collections at Geogetown University, the nation's oldest Jesuit institution of higher education. It is supported in part by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under award number U02MC31613, MCH Advanced Education Policy with an award of $700,000/year. The library is also supported through foundation and univerity funding. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.