Table 3.

Illustrative examples of BA's barriers to adhering to essential birth practices, coaching strategies delivered, and identified next steps in the BetterBirth trial

Barrier type	Essential birth practice	Barrier	Coaching strategy	Identified next steps
Individual level (ability or motivation)	Danger signs explained to mother/companion	“BA does not properly know. She is not properly paying attention while explaining danger signs.”	“After demonstrating to BA by role‐playing, she understood. Just after, another delivery arrived so she explained danger signs to the woman's relatives.”	“I will observe BA again if she is explaining danger signs to each patient.”
	Taking maternal BP	“BA does not know importance of taking maternal BP.”	“With help of [SCC]…motivated to take mother BP. BA took BP.”	“Continue coaching. Next visit I will observe BA.”
	Oxytocin administered right after delivery	“Lack of proper knowledge.”	“I have prepared to role‐play according to [SCC].”	“Continue coaching.”
	Oxytocin administered right after delivery	“Stock‐out.”	“Through [coach team leader], talked to MOIC [head of the facility] about oxytocin and when it will come into supply. … said that until oxytocin comes into supply, BA will order oxytocin from outside.”	“Continue coaching. Today there was no case so could not observe. Next visit I will observe.”
System level (opportunity or supply)	Handwashing	“No water in labor room.”	“When asked, BA said we should talk with [head of facility] … [who] suggested holding a meeting to understand what needs to be done. BA was still using water from bucket and water got finished before delivery and she could not wash hands.”	“[Coach supervisor] should request a meeting to resolve the water supply issue.”
	Taking the maternal temperature	“Thermometer is not in the labor room”	“Spoke to pharmacist to make thermometer available.”	“Thermometer has arrived in the [labor room]. Next visit I will observe BA to see if she is taking every patient's temperature or not.”
Both individual and system level	Taking the maternal BP	“Mercury BP machine did not have battery inside.”	“After discussing with BA, found out that BP machine's battery had died. Motivated BA to order new battery and told BA to take BP using the [SCC] as well.”	“It is not in the BA's habits to take BP yet so coaching is still necessary.”
		“BA also does not know the importance of BP.”	“BA took BP.”	—

Abbreviations: BA, birth attendant; BP, blood pressure; MOIC: Medical Officer in Charge (Physician in charge of the facility); SCC, WHO Safe Childbirth Checklist.