title: Widespread non-adherence to evidence-based maternity care guidelines: a population-based cluster randomised household survey.
abstract: OBJECTIVE
  To assess the quality of maternity care in an Indian metropolitan city.
  
  
  METHODS
  Three-stage cluster randomised cross-sectional survey.
  
  
  METHODS
  Sixty selected colonies of Delhi.
  
  
  METHODS
  One thousand eight hundred and one subjects (of 2286 eligible) were enrolled from 118 446 houses. Women who had delivered a live viable birth in the past 6 months were selected for the study.
  
  
  METHODS
  In stage 1, 20 wards (of 150) were selected using a probability-proportionate-to-size systematic method. In stage 2, one colony from each income stratum (high, middle and low) was selected from each ward by simple random sampling. In stage 3, a house-to-house survey was conducted to recruit 30 women for administering a peer-reviewed and pilot-trialled questionnaire.
  
  
  METHODS
  Caesarean section rate, induction rate and episiotomy rate.
  
  
  RESULTS
  National health targets such as iron supplementation advice (>96%), tetanus vaccination (>81%), and ≥3 antenatal visits (>90%) were largely achieved across health care facilities but not in home deliveries. Interventions were lower in public than private hospitals: caesarean section [23.7% (20.2-27.7) versus 53.8% (49.3-58.3)], induction [20.6% (17.5-24.25) versus 30.8% (26.8-33.2)] and episiotomy [57.8% (52.3-63.1) versus 79.4% (71.0-85.9)]. Private hospitals achieved better labour support rates [1.1% (0.5-2.2) versus 14.6% (8.5-24.1)] and pain relief [0.9% (0.4-2.0) versus 9.9 (6.5-14.8)]. Pubic hair shaving [16.2% (11.5-22.5) versus 36.4% (29.9-43.4)], enema [20.2% (15.5-26.0) versus 57.3% (49.5-64.8)], and IV fluids during labour [44.0% (36.2-52.2) versus 38.7% (29.3-49.1)] were widely prevalent in public and private hospitals.
  
  
  CONCLUSIONS
  Present practices fall short of evidence-based guidelines, with relative overuse of interventions in private hospitals and deficiency of patient-centred practices such as labour support in public hospitals.
authors.affiliation: Sitaram Bhartia Institute of Science and Research, New Delhi, India.
authors.forename: J
authors.initials: J
authors.lastname: Nagpal
authors.forename: A
authors.initials: A
authors.lastname: Sachdeva
authors.forename: R
authors.initials: R
authors.lastname: Sengupta Dhar
authors.forename: V L
authors.initials: VL
authors.lastname: Bhargava
authors.forename: A
authors.initials: A
authors.lastname: Bhartia
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004733:Enema / Q000706:statistics & numerical data; D004841:Episiotomy / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006700:Home Childbirth / Q000592:standards / Q000706:statistics & numerical data; D016304:Hospitals, Private / Q000592:standards* / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007194:India; D007751:Labor, Induced / Q000706:statistics & numerical data; D007743:Labor, Obstetric; D059408:Pain Management / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards / Q000706:statistics & numerical data; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data; D019037:Urban Health Services / Q000592:standards* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Caesarean rate; India; evidence-based medicine; maternity care; quality of care; survey