Implementation of the clinical practice guideline on intrapartum care for low-risk births in Belgium

Background

The newest Belgian clinical practice guideline on intrapartum care for low-risk births requires support to facilitate its implementation, as merely presenting guidelines does not guarantee adoption by end-users.

Aim

To systematically identify and prioritise clinical questions that need greater implementation support, understand the context of barriers and facilitators to implementation, and define a set of healthcare behavioural implementation activities for Belgian maternity services.

Methods

We employed an integrated knowledge translation approach, combining the Knowledge-To-Action and Intervention Mapping frameworks. This approach involves identifying clinical questions that require enhanced implementation support, analysing barriers within the context, and defining change and performance objectives. Feedback from a Belgian multi-stakeholder consulting group and Advisory Board informed the process.

Findings

Two clinical questions require greater support for implementation: (1) initial clinical investigations during labour and (2) ongoing investigations and interventions during a low-risk birth. Barriers to applying the recommendations include individual healthcare professional factors and professional interactions. Implementation demands healthcare professionals recognise the physiological aspects of labour and birth, stay updated on the evidence, accept the evidence supporting the management of low-risk births, and involve shared decision-making while seeking the woman’s consent. Achieving behavioural change consists of shifting attitudes, intentions, knowledge, social norms, and skills.

Discussion

The identified barriers to implementing recommendations emphasise the crucial role of interpersonal dynamics in successful guideline implementation. Therefore, policies should tackle structural challenges within Belgian maternity care.

Conclusion

To enhance maternity care services, communication, collaboration, and mutual understanding across professional boundaries are needed.