BACKGROUND The BetterBirth trial tested the effect of a peer coaching program around the WHO Safe Childbirth Checklist for birth attendants in primary-level facilities in Uttar Pradesh, India on a composite measure of perinatal and maternal mortality and maternal morbidity. This study aimed to examine the adherence to essential birth practices between two different cadres of birth attendants-nurses and auxiliary nurse midwives (ANMs)-during and after a peer coaching intervention for the WHO Safe Childbirth Checklist. METHODS This is a secondary analysis of birth attendant characteristics, coaching visits, and behavior uptake during the BetterBirth trial through birth attendant surveys, coach observations, and independent observations. Descriptive statistics were calculated overall, and by staffing cadre (staff nurses and ANMs) for demographic characteristics. Logistic regression using the Pearson overdispersion correction (to account for clustering by site) was used to assess differences between staff nurses and ANMs in the intervention group during regular coaching (2-month time point) and 4 months after the coaching program ended (12-month time point). RESULTS Of the 570 birth attendants who responded to the survey in intervention and control arms, 474 were staff nurses (83.2%) and 96 were ANMs (16.8%). In the intervention arm, more staff nurses (240/260, 92.3%) received coaching at all pause points compared to ANMs (40/53, 75.5%). At baseline, adherence to practices was similar between ANMs and staff nurses (~ 30%). Overall percent adherence to essential birth practices among ANMs and nurses was highest at 2 months after intervention initiation, when frequent coaching visits occurred (68.1% and 64.1%, respectively, p = 0.76). Practice adherence tapered to 49.2% among ANMs and 56.1% among staff nurses at 12 months, which was 4 months after coaching had ended (p = 0.68). CONCLUSIONS Overall, ANMs and nurses responded similarly to the coaching intervention with the greatest increase in percent adherence to essential birth practices after 2 months of coaching and subsequent decrease in adherence 4 months after coaching ended. While coaching is an effective strategy to support some aspects of birth attendant competency, the structure, content, and frequency of coaching may need to be customized according to the birth attendant training and competency. TRIAL REGISTRATION ClinicalTrials.gov: NCT2148952; Universal Trial Number: U1111-1131-5647.

中文翻译：

---

护士和辅助助产士在印度北方邦的同伴指导下坚持基本的分娩习惯：对BetterBirth试验的次要分析。

背景BetterBirth试验测试了围绕卫生组织安全分娩清单的同伴教练计划对印度北方邦基层设施的接生员的围产期和孕产妇死亡率以及孕产妇发病率的综合影响。这项研究的目的是在世卫组织《安全分娩检查表》的同伴指导干预期间和之后，对两个不同的接生服务干部-护士和辅助护士助产士（ANM）之间的基本分娩实践的遵守情况进行研究。方法这是对BetterBirth试验期间接生员特征，教练探访和行为摄取的辅助分析，方法是进行接生员调查，教练观察和独立观察。描述性统计数据是整体计算得出的，并通过配备干部（工作人员护士和ANM）来了解人口特性。使用Pearson过度分散校正的Logistic回归（以按地点分组）来评估干预组在常规教练（2个月的时间点）和教练计划结束后4个月（12-月时间点）。结果在对干预和控制武器进行调查的570名接生员中，有474名是工作护士（占83.2％），有96名是助理产妇（占16.8％）。在干预部门中，与ANM相比，在所有暂停点接受培训的职员护士（240/260，92.3％）更高（40 / 53，75.5％）。基线时，ANM和职员护士对实践的遵守程度相似（约30％）。干预开始后的2个月，发生频繁的教练拜访时，ANM和护士对基本分娩习惯的总体遵守率最高（分别为68.1％和64.1％，p = 0.76）。在结束培训的4个月后的12个月，ANM中的练习依从性下降到49.2％，而在职护士中下降到56.1％（p = 0.68）。结论总体而言，ANM和护士对教练干预的反应相似，在进行了2个月的指导后，对基本分娩实践的依从性百分比增幅最大，而在结束指导后4个月，依从性下降。虽然辅导是支持接生员能力某些方面的有效策略，但可能需要根据接生员的培训和能力来定制辅导的结构，内容和频率。试验注册ClinicalTrials.gov：NCT2148952；通用试验号：U1111-1131-5647。