Introduction: Women delivering in some hospitals in developing countries are routinely subjected to a variety of uncomfortable interventions, including enemas, rectal examinations, starvation, shaving, and episiotomy. We have been exploring approaches to improve the quality and humanity of obstetric care in developing countries by using systematic reviews around routine care as a way of engaging clinicians and midwives in a process of change.

Objectives:

Methods: We selected 6-10 procedures where good evidence about benefits and harms exist and which are likely to be important to women during labour. We sought how obstetricians and midwives reported that they would manage women during labour in relation to these procedures using vignettes, and their perceptions of constraints to good practice. We examined actual practice through records, and interviewed women about the care they received.

Results: Early analysis from Zimbabwe shows midwives in particular have been less exposed to the findings of systematic reviews, and hold many traditional beliefs. Most advocate episiotomy for women having their first baby, and are in favour of routine enemas in early labour. There are particular resource problems with introducing some interventions shown to be of benefit, such as social support during labour.

Discussion: Focusing on particular indicators of good obstetric practice relevant to women in labour shows promise to improving evidence-based practice. In addition, managers need to delineate viewpoints of the various stakeholders, including women, doctors, and midwives, in bringing about organisational change.