Get access

Hospital Practice Versus Evidence-Based Obstetrics: Categorizing Practices for Normal Birth in an Egyptian Teaching Hospitala

Authors

  • Karima Khalil MBBCh, MPH,

    1. At the time of the study, Karima Khalil was the Reproductive Health Program Coordinator at the Population Council, West Asia & North Africa Regional Office; Amr Elnoury is Assistant Professor of Obstetrics and Gynecology, National Laser Institute, Cairo University; Mohamed Cherine is Obstetrics and Gynecology Consultant, Galaa Teaching Hospital; Hania Sholkamy is Assistant Professor of Anthropology, Social Research Center, American University in Cairo; Nevine Hassanein is Ob/Gyn Consultant to John Snow Inc., Cairo; Lamia Mohsen is Professor of Neonatology, Cairo University, Faculty of Medicine; Miral Breebaart is Research Assistant, Reproductive Health Program, Population Council; Abdel Aziz Shoubary is Professor of Obstetrics and Gynecology and the Director of the Galaa Teaching Hospital, Cairo, Egypt.
    Search for more papers by this author
  • Amr Elnoury FRCOG, FRCS, MD,

    1. At the time of the study, Karima Khalil was the Reproductive Health Program Coordinator at the Population Council, West Asia & North Africa Regional Office; Amr Elnoury is Assistant Professor of Obstetrics and Gynecology, National Laser Institute, Cairo University; Mohamed Cherine is Obstetrics and Gynecology Consultant, Galaa Teaching Hospital; Hania Sholkamy is Assistant Professor of Anthropology, Social Research Center, American University in Cairo; Nevine Hassanein is Ob/Gyn Consultant to John Snow Inc., Cairo; Lamia Mohsen is Professor of Neonatology, Cairo University, Faculty of Medicine; Miral Breebaart is Research Assistant, Reproductive Health Program, Population Council; Abdel Aziz Shoubary is Professor of Obstetrics and Gynecology and the Director of the Galaa Teaching Hospital, Cairo, Egypt.
    Search for more papers by this author
  • Mohamed Cherine MRCOG, MD,

    1. At the time of the study, Karima Khalil was the Reproductive Health Program Coordinator at the Population Council, West Asia & North Africa Regional Office; Amr Elnoury is Assistant Professor of Obstetrics and Gynecology, National Laser Institute, Cairo University; Mohamed Cherine is Obstetrics and Gynecology Consultant, Galaa Teaching Hospital; Hania Sholkamy is Assistant Professor of Anthropology, Social Research Center, American University in Cairo; Nevine Hassanein is Ob/Gyn Consultant to John Snow Inc., Cairo; Lamia Mohsen is Professor of Neonatology, Cairo University, Faculty of Medicine; Miral Breebaart is Research Assistant, Reproductive Health Program, Population Council; Abdel Aziz Shoubary is Professor of Obstetrics and Gynecology and the Director of the Galaa Teaching Hospital, Cairo, Egypt.
    Search for more papers by this author
  • Hania Sholkamy PhD,

    1. At the time of the study, Karima Khalil was the Reproductive Health Program Coordinator at the Population Council, West Asia & North Africa Regional Office; Amr Elnoury is Assistant Professor of Obstetrics and Gynecology, National Laser Institute, Cairo University; Mohamed Cherine is Obstetrics and Gynecology Consultant, Galaa Teaching Hospital; Hania Sholkamy is Assistant Professor of Anthropology, Social Research Center, American University in Cairo; Nevine Hassanein is Ob/Gyn Consultant to John Snow Inc., Cairo; Lamia Mohsen is Professor of Neonatology, Cairo University, Faculty of Medicine; Miral Breebaart is Research Assistant, Reproductive Health Program, Population Council; Abdel Aziz Shoubary is Professor of Obstetrics and Gynecology and the Director of the Galaa Teaching Hospital, Cairo, Egypt.
    Search for more papers by this author
  • Nevine Hassanein MBBCh,

    1. At the time of the study, Karima Khalil was the Reproductive Health Program Coordinator at the Population Council, West Asia & North Africa Regional Office; Amr Elnoury is Assistant Professor of Obstetrics and Gynecology, National Laser Institute, Cairo University; Mohamed Cherine is Obstetrics and Gynecology Consultant, Galaa Teaching Hospital; Hania Sholkamy is Assistant Professor of Anthropology, Social Research Center, American University in Cairo; Nevine Hassanein is Ob/Gyn Consultant to John Snow Inc., Cairo; Lamia Mohsen is Professor of Neonatology, Cairo University, Faculty of Medicine; Miral Breebaart is Research Assistant, Reproductive Health Program, Population Council; Abdel Aziz Shoubary is Professor of Obstetrics and Gynecology and the Director of the Galaa Teaching Hospital, Cairo, Egypt.
    Search for more papers by this author
  • Lamia Mohsen MD,

    1. At the time of the study, Karima Khalil was the Reproductive Health Program Coordinator at the Population Council, West Asia & North Africa Regional Office; Amr Elnoury is Assistant Professor of Obstetrics and Gynecology, National Laser Institute, Cairo University; Mohamed Cherine is Obstetrics and Gynecology Consultant, Galaa Teaching Hospital; Hania Sholkamy is Assistant Professor of Anthropology, Social Research Center, American University in Cairo; Nevine Hassanein is Ob/Gyn Consultant to John Snow Inc., Cairo; Lamia Mohsen is Professor of Neonatology, Cairo University, Faculty of Medicine; Miral Breebaart is Research Assistant, Reproductive Health Program, Population Council; Abdel Aziz Shoubary is Professor of Obstetrics and Gynecology and the Director of the Galaa Teaching Hospital, Cairo, Egypt.
    Search for more papers by this author
  • Miral Breebaart BA,

    1. At the time of the study, Karima Khalil was the Reproductive Health Program Coordinator at the Population Council, West Asia & North Africa Regional Office; Amr Elnoury is Assistant Professor of Obstetrics and Gynecology, National Laser Institute, Cairo University; Mohamed Cherine is Obstetrics and Gynecology Consultant, Galaa Teaching Hospital; Hania Sholkamy is Assistant Professor of Anthropology, Social Research Center, American University in Cairo; Nevine Hassanein is Ob/Gyn Consultant to John Snow Inc., Cairo; Lamia Mohsen is Professor of Neonatology, Cairo University, Faculty of Medicine; Miral Breebaart is Research Assistant, Reproductive Health Program, Population Council; Abdel Aziz Shoubary is Professor of Obstetrics and Gynecology and the Director of the Galaa Teaching Hospital, Cairo, Egypt.
    Search for more papers by this author
  • Abdel Aziz Shoubary MBBCh, MSc

    Corresponding author
    1. At the time of the study, Karima Khalil was the Reproductive Health Program Coordinator at the Population Council, West Asia & North Africa Regional Office; Amr Elnoury is Assistant Professor of Obstetrics and Gynecology, National Laser Institute, Cairo University; Mohamed Cherine is Obstetrics and Gynecology Consultant, Galaa Teaching Hospital; Hania Sholkamy is Assistant Professor of Anthropology, Social Research Center, American University in Cairo; Nevine Hassanein is Ob/Gyn Consultant to John Snow Inc., Cairo; Lamia Mohsen is Professor of Neonatology, Cairo University, Faculty of Medicine; Miral Breebaart is Research Assistant, Reproductive Health Program, Population Council; Abdel Aziz Shoubary is Professor of Obstetrics and Gynecology and the Director of the Galaa Teaching Hospital, Cairo, Egypt.
      * Karima Khalil, 9 Shagarat al Dur, Apt 15, Zamalek, Cairo, Egypt.
    Search for more papers by this author

  • a

    The study was supported by the Population Council West Asia and North Africa Regional reproductive health program in Cairo, Egypt, with support from: the Ford Foundation Cairo Office; the Challenges in Changing Childbirth Program at the American University in Beirut's Faculty of Health Sciences, supported by the Wellcome Trust; the Reproductive Health Working Group; the Social Research Center at the American University in Cairo; and the Population Council, Cairo, Egypt.

* Karima Khalil, 9 Shagarat al Dur, Apt 15, Zamalek, Cairo, Egypt.

Abstract

ABSTRACT: Background:Little is known of common normal labor hospital practices in Egypt or of their relationship to evidence-based obstetrics. This study documented facility-based practices for normal labor and delivery in Egypt for the first time by categorizing 44 practices observed in a busy obstetric teaching hospital according to the World Health Organization (WHO) Technical Working Group on Normal Birth classification of normal birth practices. Methods:A multidisciplinary approach combined directly observing practices that were applied to individual laboring women and their newborns, observing ward activities, interviews, and focus groups. One hundred seventy-five normal births were observed in their entirety, over 28 days and nights, by medically trained observers using an observation checklist that documented 537 variables for each woman. Mothers were interviewed postpartum, and findings were shared with practitioners for their feedback. Observed practices were categorized according the 1999 WHO classification of 59 practices for normal birth, depending on their usefulness, effectiveness, or harmfulness. Results:There was infrequent use of beneficial practices that should be encouraged and an unexpectedly high level of harmful practices that should be eliminated. Some beneficial practices were applied inappropriately, and practices of unproved benefit were also documented, some of which are potentially harmful to childbearing mothers and their babies. Conclusions:Hospital practices for normal labor were largely not in accordance with the WHO evidence-based classification of practices for normal birth. The findings are worrying, given the increasing proportion of hospital-based births in Egypt and the country's improved but relatively high maternal and neonatal mortality rates. Obstacles to following evidence-based protocols for normal labor require examination. (BIRTH 32:4 December 2005)

Get access to the full text of this article

Ancillary