An intensive educational program for physicians and midwives involving 19 hospitals in Argentina and Uruguay dramatically reduced the rate of postpartum hemorrhage, according to researchers from the National Institutes of Health and other institutions.

Postpartum hemorrhage is excessive bleeding experienced by the mother after she gives birth. It results from failure of the uterus to contract after detachment of the placenta, or from ruptures or tears in the uterus and other tissues. The intensive educational program stressed giving the drug oxytocin to all women just after vaginal delivery, to contract the uterus and stop uterine bleeding.

The educational program also resulted in many fewer episiotomies being performed at the participating hospitals, especially among women delivering their first infant. An episiotomy is an incision in the skin between the vagina and anus. The procedure was thought to prevent tearing of the vagina during the birth process. Although many studies have shown that episiotomies are not beneficial, they are still performed in many hospitals worldwide.
"It can be difficult to change accepted medical practices," said Duane Alexander, M.D., director of the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "This successful intervention offers an effective model that can be translated into education programs suitable for interventions throughout the United States and Latin America."

The report of the large randomized controlled trial appears in the May 1 New England Journal of Medicine.

The study was funded by the Global Network for Women's and Children's Health Research, a public-private partnership between the NICHD and the Bill and Melinda Gates Foundation. The NICHD Global Network for Women's and Children's Health Research supports studies seeking to improve treatments, procedures and preventive measures that will reduce death and disability in women, infants, and children in resource poor-countries. For information on the Global network for Women's and Children's Health Research, see http://www.nichd.nih.gov/research/supported/globalnetwork.cfm.

Additional funding for the study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases.

The study's first author was Fernando Althabe, M.D., of the Institute of Clinical Effectiveness and Health Policy, in Buenos Aires, Argentina. The study also included researchers from the School of Public Health and Tropical Medicine at Tulane University, Louisiana; the Research Triangle Institute International, North Carolina; the University of North Carolina at Chapel Hill; the World Health Organization; and the NICHD.