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The cesarean delivery (CD) rate in China is 46.2%, of which 11.7% is primary elective CD. Labor analgesia varies widely in China with <1% of women receiving neuraxial analgesia (NA). The goal of the No Pain Labor N' Delivery-Global Health Initiative (NPLD-GHI) is to increase the NA rate and improve obstetric safety by establishing obstetric anesthesia training centers in China.
NPLD-GHI was launched in 2008 to assist local hospitals in the establishment of self-sustaining safe and effective obstetric anesthesia services. Annual multidisciplinary visits promote collaboration among local anesthesiologists, obstetricians, nurses/midwives and neonatologists. Bilingual protocols and Baby-on-Board, a web-based translational medical education informatics system, were developed and implemented. 4 Chinese textbooks and 2 patient education books were published. The primary education program includes: bedside instruction, daily review of goals and objectives, simulation drills, a patient education course, national policy changes and a regional conference.
Over 200 volunteers from 15 U.S. medical institutions have been involved in NPLD-GHI. 14 Chinese hospitals have participated. In approximately 35,000 patients, impact studies demonstrate increased NA use and favorable maternal and newborn outcomes (figure). 4 National practice changes include: development of milestones for obstetric anesthesia practice; a national mandate for decrease in CD; creation of a national billing code for NA; and updating of obstetrics guidelines concerning arrest of labor in the second stage.
NPLD-GHI has changed obstetric anesthesia and obstetrics practice in a positive way at the national level in China, where there are 20 million births a year. Ongoing policy initiatives, direct provider-to-provider teaching, additional sites and ongoing relationships with participating Chinese hospitals will ensure sustainability of these innovations.