Harvard testing a checklist for safer deliveries

By Chelsea Conaboy, Globe Staff

When used effectively, checklists have been shown to reduce the rate of infection and pneumonia in intensive care units. They help doctors prevent complications and even deaths in surgery.

Dr. Atul Gawande, a writer and Brigham and Women’s surgeon, has done as much as anyone to popularize the use of checklists in those settings. Now he is working with Harvard colleague Dr. Jonathan Spector, a neonatologist at Massachusetts General Hospital, to investigate what checklists could do for one of the world’s more dangerous arenas for care: the delivery room in developing countries.

For two years, the researchers have worked with the World Health Organization to develop a checklist targeting avoidable complications that lead to high numbers of deaths among mothers and newborns.

Spector said they have been encouraged by preliminary tests at 17 birth sites in countries including China, Ghana, and Pakistan. Now Harvard School of Public Health researchers will begin more fully testing the checklist in 120 hospitals in India, with the help of $14.1 million from the Bill & Melinda Gates Foundation.

In 2008, 358,000 mothers died during pregnancy or delivery, according to the World Health Organization. Worldwide, an estimated 3.1 million infants die in their first month -- an astounding figure.

“We think that most maternal and newborn deaths in low income areas are preventable, if the existing knowledge and practices are applied,” Spector said. “Many times it’s a case of limited resources, both human resources and equipment and supplies.”

The checklist will help health care providers address common complications for mothers including bleeding, high blood pressure, prolonged or obstructed labor, and infection. For babies, it will focus on factors such as suffocation and prematurity. And it will encourage patient assessments prior to discharge, to make sure the health of both mother and child is stable before going home.

But what can a checklist do for a hospital short on trained staff or money?

Ideally, it will help hospital workers to be more efficient at addressing the most immediate threats, Spector said. In many developing countries mothers are being encouraged to deliver their babies at hospitals instead of in their communities. But that has put pressure on resource-strapped facilities.

“They need tools to help them efficiently take care of many moms and babies,” Spector said.

A checklist can’t solve financial deficits, but it can help workers identify their most pressing equipment and supply needs.

“There’s really no other widely available tool that can so quickly help hospitals zero in on existing, harmful gaps,” he said.

Spector had the chance to test the checklist himself, in its early stages. He brought it along during the birth of his son, Zeke, now 20 months old. The list caught two somewhat minor things staff at the hospital had missed.

And what did his wife, Marci, think of this field work?

“I’ll be honest with you, she had her mind on other things,” he said.

Spector and Gawande plan to develop another checklist more applicable to the risk factors of delivery in the United States and other developed countries, where complications are common but the risk of dying is about 36 times lower than it is for women in developing nations.