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WHO Better Outcomes in Labour Difficulty (BOLD) project: innovating to improve quality of care around the time of childbirth.
Reproductive Health. 2015; 12:48.As most pregnancy-related deaths and morbidities are clustered around the time of childbirth, quality of care during this period is critical to the survival of pregnant women and their babies. Despite the wide acceptance of partograph as the central tool to optimize labour outcomes for over 40 years, its use has not successfully improved outcomes in many settings for several reasons. There are also increasing questions about the validity and applicability of its central feature - "the alert line" - to all women regardless of their labour characteristics. Apart from the known deficiencies in labour care, attempts to improve quality of care in low resource settings have also failed to address and integrate women's birth experience into quality improvement processes. It was against this background that the World Health Organization (WHO) embarked on the Better Outcomes in Labour Difficulty (BOLD) project to improve the quality of intrapartum care in low- and middle-income countries. The main goal of the BOLD project is to reduce intrapartum-related stillbirths, maternal and newborn mortalities and morbidities by addressing the critical barriers to the process of good quality intrapartum care and enhancing the connection between health systems and communities. The project seeks to achieve this goal by (1) developing an evidence-based, easy to use, labour monitoring-to-action decision-support tool (currently termed Simplified, Effective, Labour Monitoring-to-Action - SELMA); and (2) by developing innovative service prototypes/tools, co-designed with users of health services (women, their families and communities) and health providers, to promote access to respectful, dignified and emotionally supportive care for pregnant women and their companions at the time of birth ("Passport to Safer Birth"). This two-pronged approach is expected to positively impact on important domains of quality of care relating to both provision and experience of care. In this paper, we briefly describe the rationale for innovative thinking in relation to improving quality of care around the time of childbirth and introduce WHO current plans to improve care through research, design and implementation of innovative tools and services in the post-2015 era.Please see related articles ' http://dx.doi.org/10.1186/s12978-015-0029-4 ' and ' http://dx.doi.org/10.1186/s12978-015-0028-5 '.
Guideline: Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes.
Geneva, Switzerland, WHO, 2014.  p.This guideline is a derivative product from existing World Health Organization (WHO) recommendations on umbilical cord clamping for improving maternal and infant outcomes. The optimal timing of umbilical cord clamping has been debated in the scientific literature for at least a century, and the timing of cord clamping continues to vary according to clinical policy and practice. “Early” cord clamping is generally carried out in the first 60 seconds after birth (most commonly in the first 15-30 seconds), whereas “delayed” (also referred to as “late”) cord clamping is generally carried out more than 1 min after the birth or when the umbilical cord pulsation has ceased. For the mother, delayed cord clamping is one of the actions included in a package for reduction of the risk of postpartum haemorrhage. Member States have requested guidance from WHO on the effects of delayed cord clamping for improving maternal and infant nutrition and health, as a public health strategy in support of their efforts to achieve the Millennium Development Goals, in particular, reduction of child mortality (MDG 4) and improvement of maternal health (MDG 5), as well as the global targets set in the Comprehensive implementation plan on maternal, infant and young child nutrition. The guideline is intended for a wide audience, including policy-makers; their expert advisers; technical and programme staff at organizations involved in the design, implementation and scaling-up of nutrition actions for public health; and health staff providing care to mothers and their infants. (Excerpt)
Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting. WHO recommendations.
Geneva, Switzerland, World Health Organization [WHO], 2012.  p.The World Health Organization’s recommendations on optimizing the roles of health workers aim to help address critical health workforce shortages that slow down progress towards the health-related Millennium Development Goals. A more rational distribution of tasks and responsibilities among cadres of health workers can significantly improve both access and cost-effectiveness -- for example by training and enabling ‘mid-level’ and ‘lay’ health workers to perform specific interventions otherwise provided only by cadres with longer (and sometimes more specialized) training. These recommendations are intended for health policy-makers, managers and other stakeholders at a regional, national and international level. WHO hopes that countries will adapt and implement them to meet local needs. The recommendations were developed through a formal, structured process including a thorough review of available evidence. The process and the recommendations are described in the related documents.
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2011.  p. (WHO/RHR/11.10)The primary goal of the present guidelines is to improve the quality of care and outcomes for pregnant women undergoing induction of labour in under-resourced settings. The target audience of these guidelines includes obstetricians, midwives, general medical practitioners, health-care managers and public health policy-makers. The guidance provided is evidence-based and covers selected topics related to induction of labour that were regarded as critical priority questions by an international, multidisciplinary group of health-care workers, consumers and other stakeholders. This evidence base includes chapters on indications, methods, treatment of uterine hyperstimulation and setting.
Geneva, Switzerland, WHO, 2011.  p.The primary goal of the present guidelines is to improve the quality of care and outcomes for pregnant women undergoing induction of labour in under-resourced settings. The target audience of these guidelines includes obstetricians, midwives, general medical practitioners, health-care managers and public health policy-makers. The guidance provided is evidence-based and covers selected topics related to induction of labour that were regarded as critical priority questions by an international, multidisciplinary group of health-care workers, consumers and other stakeholders.