TY - JOUR T1 - Baseline Assessment of Evidence-Based Intrapartum Care Practices in Medical Schools in 3 States in India: A Mixed-Methods Study JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-21-00590 VL - 10 IS - 2 SP - e2100590 AU - Kirti Iyengar AU - Madhu Gupta AU - Swarnika Pal AU - Kiranjit Kaur AU - Neena Singla AU - Madhur Verma AU - Anchal Dhiman AU - Rimpi Singla AU - Minakshi Rohilla AU - Vanita Suri AU - Neelam Aggarwal AU - Tarundeep Singh AU - Poonam Goel AU - N. K. Goel AU - Reena Pant AU - Kusum Lata Gaur AU - Hanslata Gehlot AU - Indra Bhati AU - Manoj Verma AU - Sudesh Agarwal AU - Rekha Acharya AU - Keerti Singh AU - Madhubala Chauhan AU - Radha Rastogi AU - Renu Bedi AU - Poornima Pancholi AU - Bipin Nayak AU - Bhavesh Modi AU - Kanaklata Nakum AU - Atul Trivedi AU - Shonali Aggarwal AU - Sangita Patel Y1 - 2022/04/28 UR - http://www.ghspjournal.org/content/10/2/e2100590.abstract N2 - Key FindingsIn the study medical schools, we observed providers using several harmful or unnecessary practices on pregnant women in labor, including routine pubic shaving, enema on admission, routine episiotomy, application of fundal pressure, delivery in the lithotomy position, and unindicated augmentation.Barriers to adherence to the recommended evidence-based intrapartum practices included fear of perineal tear/injury to the baby in different birthing positions; lack of physical space, resources, and time; and outdated knowledge and beliefs of faculty and labor room staff.Key ImplicationsAdvocacy efforts are needed with medical councils and state departments governing medical education to strengthen training and upscale skills and provide resources to support positive childbirth experiences for laboring women.Capacity building of medical educators and staff through organizing continued medical education, skill development, teacher's training programs, and refresher courses on evidence-based practices should be done. Medical schools' curricula should include lectures and practical sessions on evidence-based intrapartum care practices, neonatal care, and respectful maternity care in medical schools.Implementation research should be carried out in the medical schools to develop optimum need-based interventions to bring about sustainable changes in medical school practices as per the recommended evidence-based guidelines.Introduction:Implementation research with pre- and post-comparison was planned to improve the quality of evidence-based intrapartum care services in Indian medical schools. We present the baseline study results to assess the status of adherence to intrapartum evidence-based practices (IP-EBP) in study schools in 3 states in India and the perception of the faculty.Methods:A concurrent mixed-methods approach was used to conduct the baseline assessment in 9 medical schools in Rajasthan, Gujarat, and Union Territory from October 2018 to June 2019. IP-EBP among pregnant women in uncomplicated first (n=135), second (n=120), and third stage (n=120) of labor were observed using a predesigned, pretested checklist quantitatively. We conducted in-depth interviews with 33 obstetrics and gynecology faculty to understand their perceptions of intrapartum practices. Quantitative data were analyzed using SPSS (version 22). COM-B (Capability, Opportunity, and Motivation Behavior) model was used to understand the behaviors, and thematic analysis was done for the qualitative data.Findings:Unindicated augmentation of labor was done in 64.4%, fundal pressure applied in 50.8%, episiotomy done in 58.3%, and delivery in lithotomy position was performed in 86.7% of women in labor.Conclusions:Intrapartum practices that are not recommended were routinely practiced in the study medical schools due to a lack of staff awareness of evidence-based practices and incorrect beliefs about their impact. ER -