Assessment of care in labour in a delivery ward in Gulbarga, India

Background: Complications during pregnancy and childbirth are one of the leading causes of disability and death among women of reproductive age in developing countries, and approximately one fifth of the maternal deaths worldwide occur in India. The outcome for mother and child is strongly related to the access of health-care and the way care in labour is carried out, and WHO states that a skilled birth attendant is the single most effective way to make deliveries safe. The way care during labour is carried out and what is considered a ―normal birth‖ varies a lot between different regions and the guidelines for how deliveries should be managed in the best way are constantly changing as new evidence arises and more research is done. The aim of this study is to assess how care in normal labour is managed in a delivery ward in Gulbarga, India. Method: A non-experimental cross-sectional study was performed during a five week period. Data was collected through a questionnaire that was completed by the birth attendants after each delivery. The questionnaire consisted of a measurement tool for care in normal birth, the Bologna Score, and additional questions regarding labour management and outcome for mother and baby. Results: According to the Bologna Score, the maximum score of five indicates that labour has been managed in an evidence-based way. The mean Bologna Score in this study was 0,72 points. The low scores were a result of that no women gave birth in a non-supine position in this setting and that the use of a partograph and early skin-to-skin contact was rarely practised. More than half of the women in this study had a high-risk pregnancy and in 73 percent of the deliveries one or more augmentations were used. The prevalence of caesarean section and artificial stimulation of labour was significantly higher in the obstetrical primiparous women than in the multiparous women. Conclusions: The findings in this study indicate that care in labour in this setting is managed according to scientific evidence to a low extent. However there are limitations in the usefulness of the Bologna Score as the reliability and validity of this measurement tool for care in labour can be questioned as it consists of few variables that not always accurately measure what it is intended to measure