Client-centered innovations in maternity care in Russia: Lessons learned from Maternal and Child Health Initiative (MCHI)

Background

The USAID-funded Maternal and Child Health Initiative (MCHI) is oriented at promoting the dissemination of effective care during pregnancy and childbirth. The project puts a major emphasis on the clients' needs and interests. Medical staff trainings, guidelines and policies within the project's framework are all based on evidence and highlight the importance of client-centered care and implementation of some underused noninvasive but beneficial practices.

Methods

A retrospective medical record review of 14 026 deliveries was performed between 2003 and 2006. A facility-based survey was conducted: 11,000 women in 17 Russian regions were interviewed between 2004 and 2006.

Results

The average frequency of cesarean sections decreased from 20, 8 % in 2003 to 18, 9 % in 2006. Women's families became more involved with support during labor: 4.6% families in 2004 as compared to 29% in 2006. The use of non-medical methods of pain relief during labor, including a warm bath and shower, increased from 5, 3% in 2003 to 80, 1% in 2006. The number of women who were allowed light food and water intake increased from 58,9% in 2004 to 91% in 2006. The number of deliveries in non-supine position increased from 9% to 25%. The amount of women giving birth in the pilot maternities increased by 40.9 %.

Conclusions

The beneficial and cost-effective methods advocated by MCHI had a very positive impact on the maternity care practices and resulted in the increased satisfaction of both, clients and health care providers, and increased attractiveness of maternities in Russia.