Barriers to integrating evidence-based practices into intrapartum care during vaginal births: a descriptive qualitative study in Sri Lanka.

Abstract

This study intended to investigate barriers to implementing evidence-based intrapartum care during vaginal births, from maternity care providers' point of view. A descriptive qualitative study was conducted using in-depth interviews, with data analysed through thematic analysis. The labour room of a major tertiary care hospital in Central Sri Lanka. Purposively selected 17 maternity care providers including doctors, nurse managers, nurse-midwives and midwives. Three major themes and twelve sub-themes were generated: (1) barriers related to care providers (lack of human resources, negative attitudes of care providers, poor relationship among care providers, poor relationship between women and care providers, lack of knowledge on evidence-based practice in childbirth care); (2) barriers related to organisational environment (gaps in management, heavy workload, inadequate physical resources, insufficient in-service training and lack of availability/use of updated guidelines) and (3) barriers related to women's birth preparedness (women's limited knowledge on childbirth and intrapartum practices and women's limited engagement during labour and childbirth). Many maternity care providers perceived that prevailing challenges to implement evidence-based childbirth care were one of the major reasons that impacted the quality of current childbirth care in the labour room. The findings showed that an integrative approach may be essential to address the diverse barriers to the implementation of evidence-based intrapartum care. It is necessary to engage healthcare administrators, healthcare professionals and care recipients to enhance the quality of current childbirth care in the setting through the successful implementation of evidence-based care.