Post-partum tubal ligation by nurse-midwives and doctors in Thailand

Abstract

A shortage of doctors limits the provision of post-partum sterilisation services in rural areas of Thailand. To overcome this problem nurse-midwives with theatre experience were trained to perform post-partum tubal ligation by a mini-laparotomy incision under local anaesthesia. The performance of the nurse-midwives was compared with that of doctors in a controlled, randomised clinical trial. Some operative difficulty was encountered by the nurses in 4.9% of cases and by the doctors in 2.0% of cases. This difference is not statistically significant and arose largely because the nurse-midwife cases were more obese. Nurse-midwives required a significantly longer operating-time (18.5 min) than doctors (11.9 min). However, postoperative morbidity was similar in the two groups (7.0% and 6.0%, respectively). These results suggest that trained nurse-midwives with theatre experience can safely provide post-partum sterilisation services. A further field trial is underway.

PIP: A randomized controlled clinical study of the competence of operating-room nurses in performing tubal ligation as compared with that of doctors was conducted. 5 nurse-midwives with more than 1 year's experience as operating room assistants were selected from the Khon Kaen Maternal and Child Health (MCH) center, and were taught pelvic and abdominal anatomy and the principles of local anesthesia and postpartum tubal ligation. Each of the 5 nurse-midwives was required to perform 30 sterilizations and 3 doctors were required to perform 150 operations. All subjects were healthy volunteers with no history of abdominal surgery; they were randomly allocated to either a trained nurse-midwife or a doctor for the operation. No statistically significant difference in the number of difficult cases were encountered by the 2 operator groups. Average operating time required by nurse-midwives (18.5 minutes) was significantly longer than that needed by doctors (11 minutes) (t=12.7, p 0.001). Thickness of abdominal fat correlated significantly with time required by nurse-midwives (r=0.34, p 0.001). Postoperative complaints and complications were similar for both groups (7.0% and 6.0%, respectively). The findings suggest that postpartum sterilization services can be safely proided by trained nurse-midwives with operating-room experience. Further study should be done to evaluate safety of the nurse-midwife providing sterilization services under usual program conditions in MCH centers and provincial hospitals with operating facilities, as well as cost-effectiveness of such services.