title: Childbirth practices in Jordanian public hospitals: consistency with evidence-based maternity care?
abstract: BACKGROUND
  In 1996, the World Health Organization stated that 'childbirth is a natural process and in normal birth, there should be a valid reason to interfere with this natural process' and encouraged practices that are evidence-based. The practices encouraged included avoiding unnecessary augmentation of labour, facilitating upright position for birth and restricting the use of routine episiotomy. Many countries have been slow to fully implement evidence-based practice in maternity care. The aim of this study was to examine maternity hospital practices in Jordan and assess their consistency with evidence-based maternity care.
  
  
  METHODS
  An explorative research design with non-participant observation was used. Data were collected from low-risk women during labour and birth using a questionnaire for maternal characteristics and an observational checklist. A proportional stratified sample was selected to recruit from three major public hospitals in Jordan. Data were analysed using descriptive statistics.
  
  
  RESULTS
  A total of 460 women were observed during labour and birth. The majority were multiparous (80%). A range of interventions were observed in women having a normal labour including augmentation (95%), continuous external fetal monitoring (77%), lithotomy position for birth (100%), and more than one third (37%) had an episiotomy with varying degrees of laceration (58%).
  
  
  CONCLUSIONS
  Childbirth practices were largely not in accordance with the World Health Organization evidence-based practices for normal birth. High levels of interventions were observed, many of which may not have been necessary in this low-risk population. Further work needs to occur to explore the reasons why evidence-based practice is not implemented in these hospitals.
authors.affiliation: Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan. dr.shaban@aabu.edu.jo
authors.forename: Insaf A
authors.initials: IA
authors.lastname: Shaban
authors.forename: Reem
authors.initials: R
authors.lastname: Hatamleh
authors.forename: Reham
authors.initials: R
authors.lastname: Khresheh
authors.forename: Caroline
authors.initials: C
authors.lastname: Homer
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000592:standards*; D055317:Evidence-Based Practice; D005260:Female; D019983:Guideline Adherence; D006771:Hospitals, Maternity / Q000592:standards*; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D007597:Jordan; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D018570:Risk Assessment; D019564:Unnecessary Procedures; D014944:World Health Organization; D055815:Young Adult