A Behavioral Intervention to Improve Obstetrical Care

In this randomized trial of a multifaceted intervention to improve obstetrical care in 19 hospitals in Argentina and Uruguay, the rate of prophylactic use of oxytocin in the third stage of labor increased from 2% at baseline to 84% after intervention at hospitals that underwent intervention and from 3% to 12% at control hospitals. The rate of episiotomy decreased from 41% to 30% at intervention hospitals but remained stable at control hospitals. In this trial of a multifaceted intervention to improve obstetrical care in Argentina and Uruguay, the rate of prophylactic use of oxytocin in the third stage of labor increased from 2% at baseline to 84% after intervention. The rate of episiotomy decreased from 41% to 30%. Effective implementation of evidence-based health care practices remains a significant challenge. 1 In maternity hospitals, evidence-based interventions often are underused, whereas ineffective or harmful practices continue to be used. For example, in the United States and Latin America, active management of the third stage of labor, consisting of the administration of a prophylactic uterotonic such as oxytocin, controlled traction of the umbilical cord, and uterine massage, 2 is used in less than 15% of deliveries. 3 – 7 In contrast, rates of the use of episiotomy among primiparous women range from 40 to 92%. 8 , 9 Active management of the third stage of labor prevents . . .