The WHO Safe Childbirth Checklist has been designed and tested to help prevent the major worldwide causes of maternal deaths, intrapartum-related stillbirths and neonatal deaths.
Could a family inclusive version of the checklist be developed and similarly tested, following WHO’s specification in 2015 that engaging with fathers is a new global priority in maternal and newborn health?
There is already in the checklist one reference to the fact that mothers are not just isolated individuals. The checklist specifies that, for every woman giving birth, a birth companion should be encouraged to be present at the birth. The 2015 Implementation Guide specifies that birth companions could be “family members, the spouse, friends, community health workers, doulas, or staff members” and recommends that they should also be informed and educated in preparation for labour and birth, for the hours after the birth and for going home. At all these stages, companions should be taught the danger signs that should trigger a call for help.
This approach does not take into full account the powerful influence of families over maternal and newborn health, and the powerful instincts of mutual protection within human families, but it is a move in that direction, recognising the importance of engaging with those around the mother.
The Family Included team has already proposed a number of principles for family inclusive care, in the form of a draft Charter, and these combine neatly with the checklist. Indeed, the family inclusive recommendation that all mothers in labour should have a birth companion, is a common point. Additional features in the Family Inclusive Charter are:
- Specific measures to communicate and implement a welcome to family members.
- Direct communication with family members (not using the mother as a go-between) before, during and after labour, taking steps to compensate actively for lack of family support should it be detected.
- Encouraging bonding between father and baby from the earliest moments (to trigger hormonal changes that in turn ‘switch on’ caring instincts and attachment).
The final clause of the draft Charter is “9. Embed family inclusiveness through education, training, policies and management.” The Implementation Guide for the Safe Childbirth Checklist gives an excellent model for how this can be done, divided into three broad stages:
- ENGAGE all stakeholders
- LAUNCH the new approach visibly
- SUPPORT change over time through a constant loop of coaching, measurement and data feedback.
Does the Checklist and the implementation plan provide a framework for a programme to test and evaluate family inclusive care?
Photo: Amy the Nurse. Creative Commons.