Table 1

Components of the intervention

Selection of opinion leaders

- Teams of 3–6 birth attendants per hospital

- Selected by peer nomination

Interactive workshops

- Opinion leaders teams will participate in a 5 day workshop

- Objectives:

- To learn the need of an evidence based clinical practice

- To develop simple evidence based guidelines about episiotomy use and management of the third stage of labor

- To identify the barriers for the adoption of those guidelines at the hospital level

- To learn how to overcome barriers and to implement the guidelines

- To adapt and organize the dissemination and implementation of the guidelines in their hospitals

Academic detailing

- Dissemination of the guidelines to hospital birth attendants in small groups and individual discussions

- Identification of barriers to implement the guidelines

- Adaptation and organization of implementation activities working closely with birth attendants.

Training on how to comply with the recommended practices

- Training in manual abilities with videos, anatomical models and patients. One day workshop.

Reminders

- Placing reminders of selective episiotomy and active management of the third stage of labor in labor and delivery wards, clinical records, and surgical packages.

Audit & feed back

- Monthly reports of hospital episiotomy and active management rates to be distributed to every birth attendant.

Information technology

- Each hospital in the intervention group will receive a computer with internet access

- A specific web site will be developed to facilitate the access to study manuals and guidelines, sources of evidence-based health care literature (Reproductive Health Library, Cochrane Library), and communication among hospitals and study coordinators

Althabe et al. BMC Women's Health 2005 5:4   doi:10.1186/1472-6874-5-4