**1. Introduction**

The high rate of maternal mortality and morbidity, especially in developing countries calls for international concern. Although the ongoing Sustainable Development Goals (SDGs) has included its prevention as one of the major indicators for measuring global development by the year 2030; success can only ensue if the challenges faced by low-resource settings are recognised and tackled. In about 130 million births per year, an estimated 303,000 result in the mother's death, and 2.6 million in stillbirths [1]. The majority of these deaths, mostly preventable, occur in low-resource settings [2, 3]. The World Health Organisation (WHO) thus developed the Safe Childbirth Checklist to support the delivery of essential birth practices for the prevention of maternal and newborn deaths [4]. The Safe Childbirth Checklist summarises the major direct causes of maternal death such as haemorrhage, hypertensive disorders, infections, and obstructed labour. The Checklist also addresses intrapartum-related stillbirths resulting from inadequate care during labour and delivery and neonatal deaths arising from birth asphyxia, complications related to prematurity, and infections. It was developed from evidence-based birth practices and tested in 10 countries across Asia and Africa [4]. Africa and Asia contribute over 90% of the world's maternal and perinatal deaths.

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Childbirth is a complex but physiological process necessitating, sometimes difficult, sometimes complicated steps that prevent adverse outcomes for the mother and her newborn child. Healthcare givers may find it difficult to simply remember all of the relevant information, and performing all the steps perfectly and in the precise order may become challenging especially in the busy labour ward. The WHO Safe Childbirth Checklist is a simple quality improvement tool that reminds healthcare workers to deliver high-quality care from when the woman is admitted, through childbirth, until the woman and baby are safely discharged home.

Checklists prompt users to remember to carry out essential tasks and have long been fundamental to maintaining safety when flying aeroplanes [5]. In other settings, professionals are successfully using checklists to organise large amounts of complex information, to remind themselves to perform crucial duties, and to ultimately do their jobs more effectively and proficiently [5]. In recent years, research on checklists in the health sector has been associated with improved safety with trials of checklist programmes in intensive care medicine and surgery demonstrating significant reductions in complications and deaths [6].

Thus, the WHO, together with obstetricians, paediatricians, nurses, midwives, patient safety experts, developed the WHO Safe Childbirth Checklist and an implementation guide [4] to help healthcare workers improve adherence to proven maternal and newborn care practices. Identifying effective methods to save lives at birth is a global priority to support progress towards the SDGs. The Safe Childbirth Checklist (**Figures 1** and **2**) is a list of evidence-based practices derived from WHO guidelines [7–15] that target the major global causes of maternal deaths (haemorrhage, hypertensive disorders, infection, and obstructed labour), intrapartumrelated stillbirths (inadequate intrapartum care) and neonatal deaths (intrapartum-related events, infection and complications of prematurity). Each checklist item is a critical action or practice that, if missed or left undone, can lead to severe harm for both the mother and or the newborn.


**1. Introduction**

discharged home.

newborn.

The high rate of maternal mortality and morbidity, especially in developing countries calls for international concern. Although the ongoing Sustainable Development Goals (SDGs) has included its prevention as one of the major indicators for measuring global development by the year 2030; success can only ensue if the challenges faced by low-resource settings are recognised and tackled. In about 130 million births per year, an estimated 303,000 result in the mother's death, and 2.6 million in stillbirths [1]. The majority of these deaths, mostly preventable, occur in low-resource settings [2, 3]. The World Health Organisation (WHO) thus developed the Safe Childbirth Checklist to support the delivery of essential birth practices for the prevention of maternal and newborn deaths [4]. The Safe Childbirth Checklist summarises the major direct causes of maternal death such as haemorrhage, hypertensive disorders, infections, and obstructed labour. The Checklist also addresses intrapartum-related stillbirths resulting from inadequate care during labour and delivery and neonatal deaths arising from birth asphyxia, complications related to prematurity, and infections. It was developed from evidence-based birth practices and tested in 10 countries across Asia and Africa [4]. Africa and

Childbirth is a complex but physiological process necessitating, sometimes difficult, sometimes complicated steps that prevent adverse outcomes for the mother and her newborn child. Healthcare givers may find it difficult to simply remember all of the relevant information, and performing all the steps perfectly and in the precise order may become challenging especially in the busy labour ward. The WHO Safe Childbirth Checklist is a simple quality improvement tool that reminds healthcare workers to deliver high-quality care from when the woman is admitted, through childbirth, until the woman and baby are safely

Checklists prompt users to remember to carry out essential tasks and have long been fundamental to maintaining safety when flying aeroplanes [5]. In other settings, professionals are successfully using checklists to organise large amounts of complex information, to remind themselves to perform crucial duties, and to ultimately do their jobs more effectively and proficiently [5]. In recent years, research on checklists in the health sector has been associated with improved safety with trials of checklist programmes in intensive care medicine and

Thus, the WHO, together with obstetricians, paediatricians, nurses, midwives, patient safety experts, developed the WHO Safe Childbirth Checklist and an implementation guide [4] to help healthcare workers improve adherence to proven maternal and newborn care practices. Identifying effective methods to save lives at birth is a global priority to support progress towards the SDGs. The Safe Childbirth Checklist (**Figures 1** and **2**) is a list of evidence-based practices derived from WHO guidelines [7–15] that target the major global causes of maternal deaths (haemorrhage, hypertensive disorders, infection, and obstructed labour), intrapartumrelated stillbirths (inadequate intrapartum care) and neonatal deaths (intrapartum-related events, infection and complications of prematurity). Each checklist item is a critical action or practice that, if missed or left undone, can lead to severe harm for both the mother and or the

surgery demonstrating significant reductions in complications and deaths [6].

Asia contribute over 90% of the world's maternal and perinatal deaths.

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 Selected Topics in Midwifery Care Improving Maternal Health: The Safe Childbirth Checklist as a Tool for Reducing Maternal… http://dx.doi.org/10.5772/intechopen.82616 

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**Figure 1.** The WHO Safe Childbirth Checklist.

92 Selected Topics in Midwifery Care Improving Maternal Health: The Safe Childbirth Checklist as a Tool for Reducing Maternal… http://dx.doi.org/10.5772/intechopen.82616 93


**Figure 1.** The WHO Safe Childbirth Checklist.


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 Selected Topics in Midwifery Care Improving Maternal Health: The Safe Childbirth Checklist as a Tool for Reducing Maternal… http://dx.doi.org/10.5772/intechopen.82616 



**2. Methodology**

guide in this chapter [4].

**3.1. Pause points**

**1.** at the time of admission;

**3.** within 1 h after birth; and

**4.** before discharge from the facility.

**3. How to use the Checklist**

supplies for use in maternity units are included.

This chapter utilises experiences gained in Cameroon, Ghana, Nigeria and Zambia during the Pfizer Independent Grant for Learning and Change supported Medical Women's Association of Nigeria Improving Maternal Health in sub-Saharan Africa project to describe how the checklist can be used to deliver lifesaving midwifery care and enhance maternal health. This chapter also outlines the 'how to use the checklist' as elucidated in the WHO implementation

Improving Maternal Health: The Safe Childbirth Checklist as a Tool for Reducing Maternal…

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This segment describes how to use the checklist to deliver life-saving birth practices. Tips on how to effectively use the checklist as a quality improvement tool, advocating and getting

The checklist is envisioned to be used at four points in time; these points are called 'pause points'. At each pause point, a set of essential practices; also known as the 'checklist items' should be completed. Each checklist item should be marked with a pen when that item is completed. The healthcare worker who is caring for the woman and baby at the time a pause point occurs should be responsible for completing the checklist then. Labour ward staff in Port Harcourt Nigeria found the checklist facilitated best practices and improved patient satisfaction with care [16].

Checklist users may be nurses, midwives, physicians, or other clinicians; as seen in Cameroon, Ghana and Nigeria. In Lusaka- Zambia, none of the sampled institutions were using the checklist. The recommended approach for using the checklist is for healthcare workers to first conduct their normal practice and then use the checklist to verify that the checklist items have been correctly performed. One checklist should be used for every mother and her baby; in Port Harcourt;

There are four pause points. Pause points are therefore the specific point in time when staff are asked to temporarily stop whatever else they are doing and verify or check that essential clinical practices have been completed [4]. Pause points thus happen at critical moments in care when complications can be averted, or adequately treated; or when it is expedient for

These pause points may not all occur in the same room. For instance, at the University of Port Harcourt Teaching Hospital Obstetric Unit in Nigeria and the Yaounde Gynaeco-Obstetric

the checklist was modified to include the mother's name and folder number (**Figure 2**).

healthcare workers to check the woman and baby. The four pause points are:

**2.** just before the woman starts pushing (or before caesarean section);

**Figure 2.** The WHO Safe Childbirth Checklist adapted for UPTH ©Rosemary Ogu.
