New Approach to Safe Deliveries: Enhancing Care for Low-Risk Childbirths Through Collaboration, study suggests

Recent study looked at ways to improve the care provided during childbirth, especially for those with low-risk pregnancies. The research team introduced a comprehensive approach that included things like audit and feedback to track progress and make improvements. They worked with different healthcare providers, such as obstetricians, midwives, and nurses, to develop strategies to enhance the quality of care for low-risk childbirths. The study took place in four different healthcare facilities in Japan, involving around 400 cases of low-risk pregnancies. The team implemented their intervention over a period of 6 months and then evaluated its impact on various aspects of childbirth care. They focused on indicators like the rate of spontaneous vaginal deliveries, uterotonic administration, and breastfeeding practices, among others. The results of the study showed that while there were some improvements, like an increase in spontaneous vaginal deliveries and uterotonic administration, not all indicators saw significant changes. The COVID-19 pandemic had an influence on the study, affecting healthcare practices and potentially masking some of the improvements that could have been achieved through the intervention. Overall, the study highlighted the importance of continuous quality improvement in healthcare, especially during challenging times like the pandemic. It showed that a multifaceted approach that includes feedback and collaboration among healthcare providers can lead to positive changes in childbirth care, although the impact may vary across different indicators. The findings suggest that ongoing efforts are needed to enhance the quality of care for low-risk pregnancies and improve outcomes for both mothers and newborns.

Key points -

- -Multifaceted Intervention Design and Implementation-: A multicentre prospective study was conducted to evaluate the impact of a multifaceted intervention combining audit and feedback with a multidisciplinary collaborative approach on the quality of care for low-risk childbirths. The intervention was implemented over six months and included educational training and ongoing quality improvement activities driven by healthcare teams.

- -Quality Indicators (QIs) Development-: 35 potential quality indicators were developed using a modified Delphi method, focusing on clinical practice guidelines specific to low-risk childbirth. After rigorous applicability assessments, 12 QIs were selected, emphasizing various aspects of care such as rates of spontaneous vaginal births, perineal lacerations, and breastfeeding initiation rates.

- -Study Population and Data Collection-: The study analyzed data from 455 eligible women who were in their late pregnancy stages and had a diagnosis of low-risk pregnancy. Data was collected using a robust system to ensure quality, and involved tracking various childbirth-related outcomes during delivery, at postpartum discharge, and at a 1-month follow-up.

- -Outcome Analysis-: Results showed a significant increase in the rate of spontaneous vaginal deliveries (risk ratio of 1.08 per month post-intervention, although the immediate level change was not statistically significant). No significant improvements were documented for the majority of other QIs, reflecting a limited impact of the intervention overall.

- -Contextual Influences-: The study highlighted the substantial impact of the COVID-19 pandemic, which may have affected the quality of care and the implementation of the intervention. Operational pressures introduced by evolving healthcare policies and staffing challenges during the pandemic could have influenced both the delivery methods and the measured outcomes.

- -Implications and Limitations-: While the intervention resulted in some positive outcomes, the lack of significant improvements across most indicators suggests they were already at high standards of quality prior to the study. Limitations included potential bias due to the COVID-19 pandemic, variations in staff experience, and inadequate data on contextual factors. The findings underscore the need for ongoing quality improvement initiatives in low-risk childbirth care, especially in challenging healthcare environments.

Reference –

K. Ueda et al. (2025). Effect Of A Multifaceted Intervention With Audit And Feedback On Low-Risk Childbirth Practice: A Multicentre Prospective Study. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07681-2.