Impact of the WHO safe childbirth checklist on birth attendant behavior and maternal-newborn outcomes: A systematic review and meta-analysis

Abstract

Background

The intrapartum period is critical for reducing maternal and perinatal morbidity and mortality. The WHO's Safe Childbirth Checklist (SCC) was designed as a reminder of the most critical, evidence-based practices (EBPs) to improve quality care and reduce preventable complications and deaths.

Objective

To assess the impact of SCC on birth attendant behavior and maternal and newborn health outcomes.

Search Strategy

A systematic review and meta-analysis was performed searching across five databases from 2009 to 2023.

Selection Criteria

We included randomized controlled trials, quasi-experimental studies, and pre/post studies.

Data Analysis

A meta-analysis yielded a pooled estimate of relative risk (RR) for adherence to and effectiveness of the SCC.

Main Results

Of 1070 articles identified, 16 were included. Use of the SCC increased adherence to EBPs by 65% (RR 1.65; 95% confidence interval [CI] 1.34–2.02). The behaviors that improved the most were danger sign counseling (RR 12.37; 95% CI 1.95–78.52; P = 0.008) and pre-eclampsia management (RR 3.43; 95% CI 1.33–8.88; P = 0.011). There was moderate evidence for stillbirth reduction (RR 0.89; 95% CI 0.80–0.99; P = 0.034).

Conclusion

There is moderate evidence demonstrating the effectiveness of the SCC in reducing stillbirths and improving adherence to EBPs.