title: Practices of skilled birth attendants during labour, birth and the immediate postpartum period in Cambodia.
abstract: OBJECTIVE
  maternal and perinatal morbidity and mortality rates in Cambodia are high. The provision of quality care by skilled birth attendants (SBAs) in a supportive working environment is an important strategy to reduce morbidity and mortality. There has been little emphasis on examining this issue in Cambodia. The objective of this study was to establish SBA reported practices during labour, birth and the immediate postpartum periods and the factors affecting this.
  
  
  METHODS
  a descriptive qualitative design was employed using in-depth interviews and focus group discussions with midwives, nurses and doctors with midwifery skills in two health centres and three referral hospitals in one province of Cambodia. Data were analysed using a thematic framework.
  
  
  RESULTS
  SBA practice is not always consistent with evidence-based standards known to reduce morbidity and mortality. Ten inter-related themes emerged, which described patterns of SBA practice, were identified. These were: skills in the care of labouring women; provision of support in labour; interventions in the second stage of labour; management of the third stage of labour; cleanliness during birth; immediate care of the newborn infant and immediate postnatal care; lack of policy and authority; fear of litigation; workload and lack of human resources; and financial incentives and socio-economic influences.
  
  
  CONCLUSIONS
  a gap exists between evidence-based standards and current SBA practice during labour, birth and the immediate postpartum care. This is largely driven by the lack of a supportive working environment.
  
  
  CONCLUSIONS
  the findings of this research provide maternal health services, workforce planners and policy makers with valuable information to contribute to the continuous quality improvement of maternity care. The findings highlight implications for practice that may improve the quality of maternal health care. Recommendations for decision makers were made and further research is needed in order to develop theories and recommendations to improve SBA practice in Cambodia, to the benefit of the Cambodia women and newborn babies.
authors.affiliation: Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Broadway, NSW 2007, Australia. ponndara.ith@student.uts.edu.au
authors.forename: Ponndara
authors.initials: P
authors.lastname: Ith
authors.forename: Angela
authors.initials: A
authors.lastname: Dawson
authors.forename: Caroline S E
authors.initials: CS
authors.lastname: Homer
authors.forename: Anna
authors.initials: A
authors.lastname: Klinken Whelan
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002160:Cambodia / Q000453:epidemiology; D002983:Clinical Competence; D036861:Delivery, Obstetric / Q000401:mortality / Q000451:nursing / Q000706:statistics & numerical data; D055317:Evidence-Based Practice / Q000592:standards; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008427:Maternal Health Services / Q000379:methods / Q000592:standards / Q000600:supply & distribution; D008880:Midwifery / Q000379:methods / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards; D011247:Pregnancy; D036301:Qualitative Research; D058996:Quality Improvement; D012959:Socioeconomic Factors