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Use of WHO standards to improve quality of maternal and newborn hospital care: a study collecting both mothers’ and staff perspective in a tertiary care hospital in Italy
  1. Marzia Lazzerini,
  2. Emanuelle Pessa Valente,
  3. Benedetta Covi,
  4. Chiara Semenzato,
  5. Margherita Ciuch
  1. WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
  1. Correspondence to Dr Marzia Lazzerini; marzia.lazzerini{at}


Background WHO developed a list of standards for improving maternal and newborn hospital care. However, there is little experience on their use, and no precise guidance on their implementation. This study aimed at documenting the use of the WHO standards for improving the quality of maternal and neonatal care (QMNC) in a tertiary hospital, Northeast Italy.

Methods The study was conducted between May 2016 and May 2018, in three phases: phase I—sensitisation and training of health professionals; phase II—data collection on the WHO standards through a survey among service users and providers; phase III—based on the findings of phase II, development of recommendations for improving the QMNC.

Results Overall, 101 health professionals were successfully trained. 1050 mothers and 105 hospital staff participated in the survey. Key indicators of QMNC (and related prevalence) from the mothers survey included: caesarean section (23.1%); episiotomy (18.3%); restrictions to free movements during labour (46.5%), lithotomy position for staff choice (69.3%); skin to skin (80.8%); early breast feeding (67.2%); information on newborn danger signs (47.2%); high satisfaction with QMNC (68.8%). Only 1.2% and 0.7% of women respectively reported discrimination or abuse. Key indicators (and prevalence) reported from staff included: availability of clinical protocols (37%); regular training (14%); health information system used for quality improvement (16.3%); training on effective communication (9.7%) and on emotional support (19.6%); protocols to prevent mistreatment and abuse (6.9%). On several indicators, the opinions of mothers on QMNC was better than those of staff. Overall, 55 quality improvement recommendations were agreed.

Conclusions Information on the WHO standards can be collected from both services users and providers and can be proactively used for planning improvements on QMNC.

  • standards of care
  • healthcare quality improvement
  • quality improvement
  • patient-centred care
  • women’s health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors ML conceived the study. ML, BC, CS, MC developed the data collections tools. EPV, BC, CS, MC collected data. EPV, BC, CS, MC analysed the data. All authors interpreted data and contributed to the manuscript. ML and EPV wrote the first draft of the paper, all authors contributed to the final version of the paper.

  • Funding This study was funded by the Institute for Maternal and Child Health IRCCS Burlo Garofolo.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Independent Ethical Review Board of the IRCCS Burlo (number protocol number: 617/2016).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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