LaQshya (Labour Room Quality Improvement Initiative)

Since the launch of the National Health Mission (NHM), there has been a significant rise in the number of women opting for hospital deliveries. However, despite these increasing numbers, we haven’t seen the expected improvements in the health outcomes for mothers and newborns. Shockingly, nearly half of maternal deaths, over 40% of stillbirths, and 40% of newborn deaths occur on the very day of delivery. It’s clear that we need a major shift in how we approach care during childbirth, focusing particularly on the crucial moments of labor and immediately after. That’s where the ‘LaQshya’ program from the Ministry of Health and Family Welfare steps in, aiming to elevate the quality of care in labor rooms and maternity operation theaters.

Goal

Reduce preventable maternal and newborn mortality, morbidity and stillbirths associated with the care around delivery in Labour room and Maternity OT and ensure respectful maternity care.

Objectives

We aim to make childbirth safer for both mothers and babies by tackling issues like bleeding during and after birth, complications with the placenta, premature birth, high blood pressure-related conditions, difficult labor, and infections.
Our goal is to provide better care during delivery and right after birth, quickly addressing any complications and ensuring timely transfers to higher-level facilities if needed. We want to establish a system where both healthcare providers and patients can communicate effectively for follow-up care.
We want every woman who comes to our health facilities to feel respected and supported during their pregnancy journey. It’s essential for us to offer compassionate and dignified care to all mothers-to-be.

Strategies

Revamp the layout and workflow of our Labour room and Maternity Operation Theatre in line with the Labour Room Standardization Guidelines and Maternal & Newborn Health Toolkit provided by the Ministry of Health & Family Welfare, Government of India.
It’s crucial to ensure that every government medical college hospital and high case-load district hospital has specialized obstetric HDUs, as recommended by the Ministry of Health & Family Welfare Guidelines. These units will be instrumental in providing critical care for complicated pregnancies, ensuring the safety of both mother and baby.
We must prioritize adherence to clinical protocols for managing and stabilizing complications before transferring patients to higher centers. This ensures that patients receive timely and appropriate care, minimizing risks and maximizing outcomes.

Interventions

Making sure we have the right number of skilled staff available to handle the workload and meet standards, with ongoing training and skill upgrades.
Assessing the skills of our labor room and maternal operating theater staff through practical exams, ensuring they can provide top-quality care for moms and newborns.
Improving staff proficiency in handling complications through hands-on training, simulations, and drills, and avoiding frequent shifts to other departments.
Training care providers to deliver respectful maternity care and closely monitoring their behavior and language.Creating a supportive environment for natural childbirth.
Following clinical guidelines and protocols to ensure safe and efficient care, including checklists for labor and surgery.
Ensuring 24/7 availability of essential services like blood transfusions, diagnostics, and medications.
Setting up triage and newborn care areas.
Conducting systematic audits of maternal and neonatal cases for continuous improvement.
Reviewing and taking action on cesarean section cases to ensure they’re done only when necessary.
Gathering feedback from patients through platforms like “Mera-Aspataal” and addressing their concerns.
Providing necessary support services like water, electricity, and cleanliness.
Using digital technology for record-keeping and monitoring, including electronic partographs.
Training staff with user-friendly materials and IT tools, and promoting facilities meeting quality standards.
Using quality improvement tools like PDCA and root cause analysis to achieve targets.
Conducting rapid improvement campaigns over six cycles, focusing on specific themes to enhance skills and performance.
Cycle 1: Real-time Partograph generation including shift to electronic partograph & usage of safe birth check-list & surgical safety check-list and strengthening documentation practices for generating robust data for driving improvement.
Cycle 2: Presence of Birth companion during delivery, respectful maternity care and enhancement of patients’ satisfaction.
Cycle 3: Assessment, Triage and timely management of complications including strengthening of referral protocols.
Cycle 4: Management of Labour as per protocols including AMTSL & rational use of Oxytocin.
Cycle 5: Essential and emergency care of Newborn & Pre-term babies including management of birth asphyxia and timely initiation of breast feeding as well as KMC for preterm newborn.
Cycle 6: Infection Prevention including Biomedical Waste Management.

Institutional Arrangement

Under the National Health Mission, states have received assistance in establishing an institutional framework to ensure quality healthcare. This includes setting up committees like the State Quality Assurance Committee (SQAC) and District Quality Assurance Committee (DQAC), along with quality teams at the facility level. These committees play a crucial role in supporting the implementation of LaQshya interventions, aiming to improve maternal and newborn care. Additionally, special purpose groups are being formed to handle technical tasks and program management. These groups will work closely with existing structures to meet specific targets and program milestones, ensuring effective coordination and progress.

Targets

Immediate (0-4 Months):

We’ll ensure that 80% of our labor rooms and maternity operation theaters (OTs) are regularly evaluated for quality and staff competence using specific checklists and practical assessments.
Setting up functional quality circles and quality teams will be a priority for 80% of our labor rooms and maternity OTs.

Short Term (up to 8 Months):

We aim to update 80% of our labor room and OT quality circles with the latest protocols, focusing on improving quality and ensuring respectful maternity care.
We’re striving for 50% of deliveries to have birth companions present.
We’ll implement safe birth and safe surgery checklists in 60% of deliveries in labor rooms and maternity OTs, respectively.
Real-time monitoring through graphs will be used in 60% of deliveries.
There will be a targeted 30% increase in breastfeeding within one hour of delivery.
Microbiological samples will be collected monthly from defined areas in 80% of labor rooms and maternity OTs.
We aim for a 30% reduction in surgical site infections for planned surgeries in the maternity OT.

Intermediate Term (Up to 12 Months):

We’re targeting a 30% increase in administering antenatal corticosteroids in cases of preterm labor.
A 30% reduction in mortality related to pre-eclampsia, eclampsia, and pregnancy-induced hypertension (PIH) is our goal.
We’re striving to decrease deaths from antepartum and postpartum bleeding by 30%.
Also, we aim to cut admissions for newborn breathing problems in special care units by 20% for babies born in our hospital.
We aim for a 20% reduction in newborn sepsis rates in SNCUs for inborn deliveries.
We target a 20% reduction in stillbirth rates.
Ensuring that 80% of beneficiaries are satisfied or highly satisfied is a priority.
We’ll reorganize 60% of labor rooms according to the “Guidelines for Standardization of Labor Rooms at Delivery Points“.
Staffing in 80% of labor rooms will meet defined norms.
Oxytocin administration immediately after birth will be 100% compliant.
We aim for a 30% improvement in the Objective Structured Clinical Examination (OSCE) scores of labor room staff.
Conducting audits and clinical discussions on maternal and neonatal complications for all maternal and neonatal deaths is essential.
We’ll strive for zero stock-outs of drugs and consumables in 80% of labor rooms and OTs.

Long Term (up to 18 Months):

Our long-term goal is for 60% of labor rooms to achieve quality certification according to the National Quality Assurance Standards (NQAS).
We aim to link 50% of labor rooms to obstetrics high-dependency units (HDUs) or intensive care units (ICUs).
We anticipate a 15% improvement in achieving our short-term and intermediate targets.
After 18 months, we plan to continue this initiative through sustained mentoring and support.

Scope

Every government medical college hospital across the country.
All district hospitals and similar healthcare facilities in each district.
Focus on FRUs and high-case-load CHCs in hilly and desert areas, delivering over 100 cases monthly.