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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 2: Low-Risk Cesarean Delivery

MCH Best Logo pregnant woman reviewing a chart with a doctor

Strategy. Multicomponent: Childbirth Education Classes + Active Management of Labor

Approach. Support the development of a statewide community-based childbirth education program + support providers in active management of labor using oxytocin infusion.

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Overview. Several studies have looked at both components of this intervention together; emerging evidence trends positive for a combined effect. Studies of multicomponent interventions trend positive overall, showing a potential reinforcement of positive behavior change.1

Evidence. Emerging. Further evaluation is needed to understand how implementation of patient + provider specific interventions affect the proportion of cesarean deliveries among low-risk first births. Access the peer-reviewed evidence on childbirth education classes through the MCH Digital Library. Access the evidence related to active management of labor. (Read more about understanding evidence ratings).

Target Audience. Patients/providers.

Outcome. Reduction of primary cesarean delivery rates among nulliparous women. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. There are currently XXX ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Support the development of a statewide community-based childbirth education program + support providers in active management of labor using oxytocin infusion,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of women receiving oxytocin in active labor in hospitals that offer a community-based childbirth education program.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of women receiving oxytocin in active labor in hospitals that offer a community-based childbirth education program.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of women who attend community-based childbirth classes who received oxytocin in active labor and delivered vaginally.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of women who attend community-based childbirth classes who received oxytocin in active labor and delivered vaginally.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


Reference:

1 Frigoletto FD, Lieberman E, Lang JM, et al. A clinical trial of active management of labor. N Engl J Med. 1995;333(12):745-750. doi:10.1056/nejm199509213331201.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.