Current Intrapartum Care Practices in India: Opinion and Beliefs on Routine Versus Evidence Based Practice During Childbirth

According to the annual report of the Government of India, 100,000 women annually continue to die because of childbirth related complications (Ministry of Health and Family Welfare (Government of India), 2000-2001). In India, over 90% of women become mothers and a majority of them deliver without skilled assistance during delivery. This translates to approximately 30 million women in India experiencing pregnancy every year, and 27 million having live births (Bakshi, 2006). Of these, 136,000 maternal deaths occur every year due to childbirth complications, most of which can be prevented. Literature reveals that lack of appropriate care during pregnancy and childbirth, and especially the inadequacy of services for detecting and managing complications, explains most of the maternal deaths. Less attention has been paid to the quality of care within hospital based-services and there is growing evidence that women receive and experience appalling care in some institutions. A convenience sample (n = 188) of maternity care providers comprising doctors and nurse-midwives was obtained from the northern states of India. A semi-structured survey questionnaire was developed with 34 items in the form of fixed-choice and open ended questions. The developed questionnaire was intended to measure the intrapartum care practices comprising six elements: episiotomy, labor induction, birthing position, labor pain management, fundal pressure, and childbirth support. Statistical Package for the Social Sciences (SPSS) software was used for descriptive analysis of the data. The findings of the study demonstrated that providing lithotomy position at the time of delivery and giving episiotomy to all primigravida mothers were highly practiced during intrapartum care. Care providers believe that episiotomy has more benefits over perineal laceration, such as easy wound healing, prevention of deep perineal lacerations, easy to deliver the baby, mother experiences less pain, and there are less chances of hematoma formation. Significant differences were found for the practice of fundal pressure between doctors and nurse-midwives (p = < .05). Maternity care providers from government and non-government hospitals had significant differences in their opinion towards conducting episiotomy for all deliveries (mean = .000) and to all primigravidas (.002). The study findings suggested that self-reported practices of maternity care providers reflect a big gap in the utilization of evidence based-practices. Hence, more descriptive and interventional studies need to be done in India to identify the barriers that may impact implementation of evidence-based practices.