The availability of labor analgesia is highly variable in the People’s Republic of China. There are widespread misconceptions, both on the part of parturients and health care providers, concerning the safety of labor epidural analgesia to the mother and/or baby. Even so, China has one of the highest caesarean delivery rates in the world with estimates exceeding 50% of all births. The goal of the nongovernmental No Pain Labor & Delivery – Global Health Initiative (NPLD-GHI) is to facilitate increases in vaginal delivery rates by increasing access to safe neuraxial labor analgesia. NPLD – GHI was launched in 2008 with the intended goal of improving labor outcomes in China by increasing labor epidural analgesia rates by at least 10%. Ideally, the program will create 10 training centers over a 10-year period to best increase these rates and increase availability of labor analgesia. This would result in reduced requests for unnecessary caesarean delivery and better labor outcomes for mother and baby.
In order to accomplish this, multidisciplinary teams of composed of more than 500 Western clinicians and support staff have traveled to China in 8 to 10 day missions to establish 24/7 obstetric anesthesia coverage in Chinese hospitals. Some activities that embody this transitional medicine approach include but is not limited to: education and modeling multidisciplinary collaborations, including problem-based learning discussions, bedside teaching, daily debriefings, simulation training drills, and weekend conferences.
As of June 2016, NPLD – GHI has engaged with 51 hospitals, encompassing a combined annual delivery rate of just over a half million. At this point, 24/7 obstetric anesthesia coverage has been established and labor epidural analgesia rates have exceeded 50% in approximately 80% of the hospitals engaged with NPLD – GHI.
Four impact studies comprising of approximately 65,000 deliveries have found lower rates of caesarean delivery, episiotomy, postpartum blood transfusion, and better neonatal outcomes after the NPLD – GHI intervention. In addition, major changes in clinical practice guidelines, medical policy, and billing codes have been implemented in conjunction with the modernization of perinatal practice that has occurred concurrently in China since the first NPLD – GHI trip in 2008.
With 20% of the world’s population inhabiting China, it is imperative that there be a nurturing and safe environment for both mother and baby in the perinatal period. NPLD-GHI has the potential to not only reach this goal but improve total global health and safety with its unique initiative approach and cooperative teaching methods. The associated film documents the methods used and impression of those involved.
The 2017 NPLD-GHI program will be centered in western China. The application period is now open. The dates will be:
||Friday:||Departure date for China;|
||Saturday:||Arrival date in China;|
||Sunday:||GHI start date;|
||Saturday:||GHI ending date;|
||Sunday:||Departure for USA.|
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