No Pain Labor & Delivery - Global Health Initiative

The availability of labor analgesia is highly variable in the People’s Republic of China. There are widespread misconceptions, both on the part of parturients and health care providers, that labor epidural analgesia is harmful to mother and/or baby. Meanwhile, China has one of the highest cesarean delivery rates in the world, exceeding 50%. The goal of the nongovernmental No Pain Labor & Delivery - Global Health Initiative (NPLD-GHI) is to facilitate sustainable increases in vaginal delivery rates by increasing access to safe neuraxial labor analgesia. The direct consequence is decreasing the overall cesarean delivery rate. NPLD - GHI was launched in 2008 with the stated goal of improving labor outcome in China by increasing the absolute labor epidural analgesia rate by 10%. NPLD - GHI ideally wishes to create 10 training centers of excellence over a 10-year period. We hypothesized that increased availability of labor analgesia would result in reduced requests for unnecessary cesarean delivery and better labor outcomes for mother and baby.

Specifically, multidisciplinary teams of Western clinicians and support staff have traveled to China for 8 to 10 days per initiative with close to 500 individual visits since its inception. The approach involves establishing 24/7 obstetric anesthesia coverage in Chinese hospitals utilizing a transitional medicine approach: education and modeling multidisciplinary collaborations, including problem-based learning discussions, bedside teaching, daily debriefings, simulation training drills, and weekend conferences.

As of June 2016, NPLD - GHI has engaged with 51 hospitals encompassing a combined annual delivery rate of over one half million. 24/7 obstetric anesthesia coverage has been established and labor epidural analgesia rates have exceeded 50% in approximately 80% of the hospitals engaged with NPLD - GHI.

Four impact studies comprising approximately 65,000 deliveries have found lower rates of cesarean delivery, episiotomy, postpartum blood transfusion, and better neonatal outcomes after the NPLD – GHI intervention. In addition, major changes in clinical practice guidelines, medical policy, and billing codes have been implemented in conjunction with the modernization of perinatal practice that has occurred concurrently in China since the first NPLD - GHI trip in 2008.

With 20% of the world's population inhabiting China, it is imperative that there be a nurturing and safe environment for both mother and baby in the perinatal period. NPLD-GHI has the potential to not only reach this goal but improve total global health and safety with its unique initiative approach and cooperative teaching methods. The associated film documents the methods used and impression of those involved.