The programme will complement the South African Society of Obstetricians and Gynaecologists' (Sasog) existing initiative, the BetterObs programme which was established during 2015 and is aimed at reducing the number of maternal deaths in South Africa.
“The implementation of the BetterGyn programme means that we will have covered the entire spectrum of women’s health issues and not just those associated with pregnancy and childbirth," says Professor Greta Dreyer, president of Sasog.
Gynaecologists and other practitioners are provided with a set of protocols aimed at the prevention and management of serious surgical complications and important conditions affecting women. Once development in the first phase has been completed, a total of 32 conditions and procedures will be covered. Surgical procedure guidelines include conditions such as hysterectomies, urinary incontinence, pelvic organ prolapse and surgical complications. Importantly, attention will also be given to cancer screening and contraception, both of which are national priorities. The programme includes information for patients to assist in the communication between practitioner and patient.
The BetterObs programme is aimed at reducing the number of maternal deaths and complications and consists of a set of protocols for best practice for 19 of the most frequent and high-risk complications occurring during childbirth, including excessive bleeding, preterm labour and caesarean section deliveries. Already introduced into all labour wards in South Africa, these guidelines, which must be adhered to by all members of the delivery team, are aimed at standardising and raising the quality of care in the labour ward.
Dreyer says that for every 100,000 live births, 134 women are losing their lives during childbirth, many from causes that could be prevented by improving infrastructure, health care systems and clinical know-how.
“Although as a country we are making progress in bringing down the number of women dying during pregnancy and childbirth, we are still losing far too many women from preventable complications such as those resulting from HIV, severe bleeding after childbirth, high blood pressure during pregnancy and infections," she says.
The BetterObs programme is a holistic approach to improving quality and outcomes and involves commitment from the obstetrician, the hospital, the attending paediatrician and the patient. Under these guidelines, obstetricians are expected to adhere strictly to the protocols and must comply with set peer review processes. Attending paediatricians are expected to complete detailed discharge summaries on each newborn and must notify the delivering obstetrician if the infant is readmitted, be it either to the same or another hospital.
Also included in the programme are compulsory mortality and morbidity (M&M) meetings attended by obstetricians and paediatricians, where complications and quality of care are scrutinised and monitored. Hospitals must ensure that meetings take place regularly and must consider withdrawing delivery rights of an obstetrician not attending these meetings.
Upon admission, hospitals must make patients aware of the programme and of the procedure to follow in the case of a complaint.
Dr Johannes van Waart, BetterObs programme leader, says that a handbook, compiled by the society, has been presented to every obstetrician in the country and has also been made available for maternity nursing staff at all hospitals. He adds that, in the case of an adverse event, the Expert Opinion Panel are requested to study all the facts and provide recommendations on their findings and the way forward, to the Sasog executive committee and the doctor involved. This panel will also refer potential litigation cases for mediation. The functions of the panel extend beyond obstetrics to the entire field of gynaecology.
“Childbirth is a dangerous process of transition with many individuals - including nurses, midwives, hospitals and obstetricians - involved in assisting a safe journey for mother and child. The aim of the BetterObs programme is to make sure that excellent patient care becomes the priority for each member of the team involved in the delivery of a baby, in order to avoid complications and death. Similarly, we strive for quality in gynaecology via BetterGyn," says Dreyer.