Adaptation and implementation of the World Health Organization's clinical guidelines on maternal and newborn care for a positive postnatal experience

Abstract

Abstract Introduction: The postpartum period is a critical time for women, babies, spouses, parents, caregivers, and families. Considering the importance of using comprehensive and up-to-date clinical guidelines in postpartum care, this study aims to adapte the clinical guidelines of the World Health Organization and implement the recommendations of the adapted clinical guidelines in Iran on maternal outcomes after childbirth. Childbirth including maternal performance, postpartum depression and specific anxiety (primary outcomes), infant care, maternal health problems, experience of violence, and a checklist of satisfaction with the quality of care (secondary outcomes) were designed and implemented. Method: This study was conducted in two parts; In the first phase, the World Health Organization's (WHO) clinical guideline for mother and child care and postnatal care were adapted, and in the second phase, the recommendations of the clinical guidelines were implemented on mothers and babies, and maternal and newborn outcomes were measured. In the first phase of this study, the ADAPTE method, which is a nine-step method for localization of clinical guidelines, was used. Using search keywords in databases, a systematic review was conducted and clinical guidelines related to postpartum care were extracted according to the inclusion criteria. The quality of clinical guidelines was evaluated using the appraisal of guidelines for research and evaluation II tool (AGREE-II). The World Health Organization's clinical guide received the highest evaluation score and was chosen as the main guide, and National Institute for Health and Care Excellence (NICE's) clinical guideline was also used in the formulation of recommendations. The recommendations were finalized by the consensus method of the experts during the first and second Delphi stages, and the recommendations of the postpartum clinical guide were compiled and sent for external evaluation. The second part of the study was a randomized controlled clinical trial that was conducted on 272 women who gave birth and were hospitalized in Taleghani and Al-Zahra hospitals in Tabriz. Sampling was done in an easy and accessible way, and after allocating the women in the immediate postpartum stage to the intervention group (the recipient of care based on WHO recommendations) and the control group (the recipient of routine hospital care), the questionnaire Demographics, obstetrics and depression were completed for them. In the intervention group, mother and baby care and training were carried out according to the recommendations of adapted clinical guidelines, mothers and their babies were followed up until 6 weeks after delivery. And the checklist of maternal health problems, infant care questionnaire, postpartum depression, specific postpartum anxiety, maternal performance, violence measurement questionnaire, and the checklist of satisfaction with the quality of care were completed, also in the second week after delivery, the check The list of maternal health problems and depression questionnaire were also completed. The data were analyzed using independent t-test, Mann-Whitney, Fisher's exact, chi-square and ANCOVA with adjustment of confounding variables. Results: The results of the adaptation section were presented in the form of 68 clinical recommendations in the thematic axes of care, prevention, treatment, education and system improvement, of which 49 recommendations are from the World Health Organization and 17 recommendations are from NICE clinical guidelines. The findings of the quantitative section showed that there was no statistically significant difference between the two groups in terms of personal-social characteristics (P<0.05). In terms of the average Barkin maternal performance score (P=0.504), postpartum depression (P=0.346), infant care (P=0.121), specific postpartum anxiety (P=0.160) ) and violence (P=0.542) did not have a statistically significant difference between the intervention and control groups. The overall frequency of maternal problems in the second week after delivery was significantly lower in the intervention group (75.7%) compared to the control group (87.5%) (P=0.012). In terms of breastfeeding in the second week after delivery, the rate of use of powdered milk was 12.9% in the intervention group and 23.4% in the control group, and the results of the chi square test showed a statistically significant difference between the two groups (P= 0.027). In terms of the use of contraceptive methods, 24.3% in the intervention group and 22.2% in the control group used safe methods of contraception, and the results of Fisher's exact test showed a statistically significant difference between showed two groups (P=0.035). Mothers' satisfaction with the trainings and recommendations provided in the intervention group was 98.5% and in the control group was 88.2%, and the results of Fisher's exact test showed a statistically significant difference between the two groups (P= 0.002). Conclusion: Providing care based on clinical guidelines is associated with increasing the frequency of breastfeeding, using safe methods of contraception and increasing mothers' satisfaction with the provided training, but it did not have a significant effect on maternal outcomes. It is suggested that the adapted clinical guide be made available to policymakers and planners and the necessary plans to implement all the recommendations of the adapted clinical guide be provided in order to take an important step towards improving Post-partum care and improvement of the post-partum experience should be removed.