The Effect of Normal Vaginal Delivery Clinical Pathway on Unnecessary Interventions at Labore in Emam Reza Hospital, Urmia

Since normal vaginal delivery is concerned with the health of the mother and her child, different levels of the healthcare system is engaged in this process, and due to the high rate of c-sections, studying issues related to normal vaginal delivery is one of the priority areas in medical research worldwide. Function of normal vaginal delivery process- like many other clinical processes- is far from optimal in Emma Reza hospital, and needs improvement. This study was carried out with the aim of development and implementation of a clinical pathway for normal vaginal delivery to improve this process. In this paper we report the results of its implementation on unnecessary interventions in labor.

Materials & Methods : This is a quality improvement study which is one of the effectiveness or on-line studies. In this study we used FOCUS PDCA as a model for clinical pathway development. At first current function of process was assessed by multidisciplinary team. Best practices for normal vaginal delivery were extracted from several data bases by using methods of evidence-based medicine. Then format and content of pathway was determined. Finally, the inclusion criteria, the main activities and possible variances from the pathway were determined. Evidence based necessary protocols and procedures were developed. In addition, a patient pathway's version was provided.

Result : Assessment of current function showed that normal vaginal delivery process was far from standard, So that the rate of unnecessary interventions was more than standard limit. We used clinical pathway method and evidence-based medicine for standardization of normal vaginal delivery process. It was piloted for two months. Data was collected before and during pilot implementation. Unnecessary interventions in criteria of: episiotomy was 78%, taking IV line/serum therapy was 99%, and augmentation of labor was 46% before implementation of pathway. They changed to 63%, 54%, and 40% as a sequence during pilot implementation.

Conclusion: Normal vaginal delivery clinical pathway was effective in reduction of unnecessary interventions in hospital.