Background: Maternal and neonatal mortality remain major global public health challenges, particularly in low- and middle-income countries such as Nigeria, where preventable complications during childbirth continue to contribute significantly to poor outcomes. Evidence-based intrapartum care is essential in reducing these deaths; however, poor adherence to standardized clinical guidelines among midwives limits optimal care delivery. The World Health Organization Safe Childbirth Checklist (WHO SCC) was developed as a quality improvement tool to enhance adherence to essential childbirth practices and improve maternal and neonatal outcomes, yet its effectiveness in Nigerian tertiary hospitals remains underreported.

Aim: This study evaluated the effect of the WHO Safe Childbirth Checklist on maternal and neonatal outcomes in selected tertiary hospitals in Rivers and Bayelsa States, Nigeria.

Methods: A cluster randomized controlled trial design was used. The study involved midwives and labouring women in selected tertiary healthcare facilities in Rivers and Bayelsa States. Hospitals were randomly assigned to intervention and control groups. Midwives in the intervention group received structured training and implementation support on the WHO Safe Childbirth Checklist, while the control group continued routine maternity care without the checklist. Data were collected on checklist utilization, maternal outcomes (eclampsia and postpartum haemorrhage), and neonatal outcomes (birth asphyxia, stillbirth, and neonatal sepsis) before and after intervention. Data were analyzed using descriptive and inferential statistics at a 0.05 significance level.

Results: There was a significant increase in WHO SCC utilization in the intervention group. Adherence to essential childbirth practices improved significantly (p < 0.001), including blood pressure monitoring, uterotonic administration, infection prevention, neonatal resuscitation preparedness, early breastfeeding initiation, and monitoring of danger signs. Maternal outcomes showed significant reductions in eclampsia and postpartum haemorrhage in the intervention group compared to controls. Neonatal outcomes also improved significantly, with reductions in birth asphyxia and neonatal sepsis. However, no significant reduction was observed in stillbirth rates (p > 0.05).

Conclusion: The WHO Safe Childbirth Checklist significantly improved adherence to essential childbirth practices and reduced selected maternal and neonatal complications. It is an effective quality improvement intervention for strengthening safe childbirth practices in tertiary healthcare settings in Nigeria.

Keywords; WHO Safe Childbirth Checklist; Maternal Outcomes; Neonatal Outcomes; Midwives; Birth Asphyxia; Eclampsia; Nigeria; Checklist Implementation.