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Evidence-informed obstetric practice during normal birth in China: trends and influences in four hospitals

Qian, Xu; Smith, Helen; Liang, Hong; Liang, Ji and Garner, Paul (2006) Evidence-informed obstetric practice during normal birth in China: trends and influences in four hospitals. BMC Health Services Research, 6 . Article Number: 29. ISSN 1472-6963

Available under License Creative Commons Attribution.


Cited 9 times in WoS


Background: A variety of international organizations, professional groups and individuals are promoting evidence-informed obstetric care in China. We measured change in obstetric practice during vaginal delivery that could be attributed to the diffusion of evidence-based messages, and explored influences on practice change. Methods: Sample surveys of women at postnatal discharge in three government hospitals in Shanghai and one in neighbouring Jiangsu province carried out in 1999, repeated in 2003, and compared. Main outcome measures were changes in obstetric practice and influences on provider behaviour. "Routine practice" was defined as more than 65% of vaginal births. Semi-structured interviews with doctors explored influences on practice. Results: In 1999, episiotomy was routine at all four hospitals; pubic shaving, rectal examination (to monitor labour) and electronic fetal heart monitoring were routine at three hospitals; and enema on admission was common at one hospital. In 2003, episiotomy rates remained high at all hospitals, and actually significantly increased at one; pubic shaving was less common at one hospital; one hospital stopped rectal examination for monitoring labour, and the one hospital where enemas were common stopped this practice. Mobility during labour increased in three hospitals. Continuous support was variable between hospitals at baseline and showed no change with the 2003 survey.Provider behaviour was mainly influenced by international best practice standards promoted by hospital directors, and national legislation about clinical practice. Conclusion: Obstetric practice became more evidence-informed in this selected group of hospitals in China. Change was not directly related to the promotion of evidence-based practice in the region. Hospital directors and national legislation seem to be particularly important influences on provider behaviour at the hospital level.

Item Type:Article
Additional Information:Published: 08 March 2006. 9 pages (page numbers not for citation purposes)
Subjects:R Medicine > RG Gynecology and obstetrics
Publisher's Statement:© 2006 Qian et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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ID Code:258
Deposited On:06 Nov 2007 13:05
Last Modified:28 Mar 2012 10:32

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