647 - Impact of training in ENC Now on Provision of Respectful Maternity and Newborn Care

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 647
Publication Number: 647.316

Henna Shaikh, Children's Hospital of Philadelphia, Seattle, WA, United States; Omkar Basnet, Golden Community, Kathmandu, Bagmati, Nepal; Beena D. Kamath-Rayne, American Academy of Pediatrics, Itasca, IL, United States; Ashish KC, Uppsala University, Uppsala, Uppsala Lan, Sweden; Sara Berkelhamer, University of Washington School of Medicine, Seattle, WA, United States

Presenting Author(s)

Henna Shaikh, MD (she/her/hers)

Pediatric Global Health Fellow
Children's Hospital of Philadelphia
Seattle, Washington, United States

Background: Respectful maternity and newborn care (RMNC) includes appropriate communication and care without discrimination. RMNC is a human rights imperative that is also associated with improved patient experiences and outcomes. The WHO has emphasized RMNC in its updated curriculum, Essential Newborn Care (ENC) and the online version, ENC Now. However, the impact of this added emphasis has yet to be defined, and the optimal approach for improving RMNC during labor and delivery remains unknown.

Objective:

1) To determine if training in ENC Now improves provision of RMNC. 2) To determine if the changes in RMNC are impacted by ethnic background.

Design/Methods:

This study was conducted at a large, tertiary hospital in Nepal. 20 nurse midwives in the high risk labor unit completed a paired ENC Now and quality improvement (QI) training that included discussion of baseline RMNC metrics and RMNC role-play. 75% of attendees had prior Helping Babies Breathe training, which included some RMNC content. Both midwives and laboring mothers consented to participation. Trained staff performed direct observation to collect data on welcoming and greeting the mother, explaining what is being done to a mother, explaining what is being done to help the baby breathe, initiating breastfeeding within 1 hour, and communicating the importance of breastfeeding. Baseline data was collected before the training (Aug 1, 2021-Jan 5, 2022) and was compared to data after this intervention (Jan 6-Apr 30, 2022).

Results:

We collected 167 baseline and 1669 post-intervention observations. Higher rates of welcoming and greeting the mother were observed after training (15.6 v 33.3%, p < 0.0001) (Table 1). An explanation of what was being done to a mother also increased (61.1 v 76.9%, p < 0.0001). Only a subset of infants required help breathing, but communication with mothers about the procedure did not increase significantly in this cohort (20.4 vs 29.8%, p = 0.176). Communication on the importance of breastfeeding decreased (27.7 vs 11.7%, p < 0.0001), but initiation of breastfeeding within the first hour increased (59.1 v 76.2%, p< 0.0001). The patterns of change were comparable in both advantageous and disadvantageous ethnic backgrounds.

Conclusion(s):

Direct observation of deliveries confirmed that improvement in RMNC can be achieved, with significant increases in metrics covered both by ENC Now training and a QI curriculum. The improvements in communication observed occurred independent of ethnic background. Further evaluation is indicated to assess optimal training approaches and to define the maternal perspective.