Search

During the French Revolution, obstetrics underwent substantial transformations in practice, teaching, and the physical spaces where it was conducted. The revolutionary authorities implemented reforms in French medical institutions that promoted an instrument-centred style and the dissemination of novel surgical techniques in obstetrics. The selection of professors for the obstetrics chair at the newly established École de santé and the appointment of chiefs for the new maternity ward in Paris favoured proponents of a mechanistic approach to labour assistance. This essay explores the theoretical principles and societal pressures that guided these transformative reforms and the remarkable changes they introduced in healthcare and in the practise of medicine and surgery. Furthermore, it examines the consolidation of new epistemological, ethical, and professional boundaries within the context of late eighteenth-century French obstetrics. A critical section of this study focuses on the debate ignited by the contemporaries who voiced concerns that the rise of surgical interventions on pregnant women's bodies might result in unwarranted violence, in a diminishing of midwives’ roles, and in a departure from the tradition of natural childbirth. These controversies among obstetricians highlight significant contradictions within the Revolutionary medical reforms. [ABSTRACT FROM AUTHOR]

Introduction The World Health Organization (WHO) Safe Surgery Checklist significantly decreases morbidity and mortality in regular operating room cases. However, significant differences in workflow and processes exist between regular operating room cases and cesarean sections performed on the labor and delivery unit. The aim of this study is to adapt the WHO Safe Surgery Checklist for the labor and delivery unit and cesarean sections to improve communication and patient safety. Methods A multidisciplinary team consisting of all major stakeholders reviewed and revised the WHO Safe Surgery Checklist making it more applicable to cesarean section operations. The new Safe Cesarean Section Checklist was tested and then integrated into the electronic medical record and utilized on the labor and delivery unit. A specific cesarean section safety attitudes questionnaire was developed, validated, and administered prior to and one year after implementation. Results Usage of the Safe Cesarean Section Checklist was greater than 95% after initial implementation. Significant improvements were reported by the staff on the cesarean section attitudes questionnaire for several key areas including the feeling that all necessary information was available at the beginning of the procedure, decreases in communication breakdowns and delays, and fewer issues related to not knowing who was in charge during the procedure. Discussion Implementation of the Safe Cesarean Section Checklist was successfully adopted by the staff, and improvements in staff perceptions of several key safety issues on our unit were demonstrated. Additional studies should be undertaken to determine if clinical outcomes from this intervention are comparable to those seen with the use of the WHO Safe Surgery Checklist., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Madigan Army Medical Center issued approval MCHJ-CLG-A. The Safe Cesarean Section Checklist was implemented for a trial period in the labor and delivery unit. During this time, a departmental policy detailing the program was drafted and signed by the department chief. This study was reviewed by the Chief of the Department of Clinical Investigation at the military treatment facility (MTF) and approved for publication as a quality improvement project with exempt status. Because this was a process/quality improvement project, that was the route of review per their process at the time when it was completed. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Patel et al.)