Evaluation of labor and childbirth care by nurse-midwives in Brazilian private hospitals: results of a quality improvement project

dc.creatorSouza, Fabrine C.
dc.creatorDomingues, Rosa Maria Soares Madeira
dc.creatorTorres, Jacqueline Alves
dc.creatorGomes, Maysa Luduvice
dc.creatorLeal, Maria do Carmo
dc.date2023-05-24T02:17:54Z
dc.date2023-05-24T02:17:54Z
dc.date2023
dc.date.accessioned2023-09-26T20:09:12Z
dc.date.available2023-09-26T20:09:12Z
dc.identifierSOUZA, Fabrine C. et al. Evaluation of labor and childbirth care by nurse-midwives in Brazilian private hospitals: results of a quality improvement project. Reproductive Health, v. 20, Suppl. 2, p. 1-12, Jan. 2023.
dc.identifier1742-4755
dc.identifierhttps://www.arca.fiocruz.br/handle/icict/58602
dc.identifier10.1186/s12978-022-01537-0
dc.identifier1742-4755
dc.identifier.urihttps://repositorioslatinoamericanos.uchile.cl/handle/2250/8849853
dc.descriptionThis work was supported, in part, by the Bill & Melinda Gates Foundation [OPP1142172] and by DECIT/MoH Brazil/CNPq [401715/2015-9]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. The funders had no influence in the identification, design, conduct, and reporting of the analysis.
dc.descriptionBackground: In 2015, a quality improvement project-the "Adequate Childbirth Project" (Projeto Parto Adequado, or PPA)-was implemented in Brazilian private hospitals with the goal of reducing unnecessary cesarean sections. One of the strategies adopted by the PPA was the implementation of labor and childbirth care by nurse-midwives. The objective of this study is to evaluate the results of the PPA in the implementation and adequacy of labor and childbirth care by nurse-midwives in Brazilian private hospitals. Methods: Cross-sectional, hospital-based study, carried out in 2017, in 12 hospitals participating in the PPA. We assessed the proportion of women assisted by nurse-midwives during labor and childbirth care and the adequacy of 13 care practices following parameters of the World Health Organization. Women assisted in the PPA model of care and in the standard of care model were compared using the chi-square statistical test. Results: 4798 women were interviewed. Women in the PPA model of care had a higher proportion of labor (53% × 24.2%, p value < 0.001) and vaginal birth (32.7% × 11.3%, p value < 0.001), but no significant differences were observed in the proportion of women assisted by nurse-midwives during labor (54.8% × 50.1%, p value = 0.191) and vaginal birth (2.2% × 0.7%, p value = 0.142). The implementation of recommended practices was adequate, except the use of epidural analgesia for pain relief, which was intermediate. There was a greater use of recommended practices including "oral fluid and food", "maternal mobility and position", "monitoring of labor", "use of non-pharmacological methods for pain relief" and "epidural analgesia for pain relief" in women assisted by nurse-midwives in relation to those assisted only by doctors. Many non-recommended practices were frequently used during labor by nurse-midwives and doctors. Conclusions: There was an increase in the proportion of women with labor and vaginal birth in the PPA model of care and an appropriate use of recommended practices in women assisted by nurse-midwives. However, there was no difference in the proportion of women assisted by nurse-midwives in the two models of care. The expansion of nursing participation and the reduction of overused practices remain challenges.
dc.formatapplication/pdf
dc.languageeng
dc.publisherBioMed Central
dc.rightsopen access
dc.subjectHealth evaluation
dc.subjectHospitals
dc.subjectMidwifery
dc.subjectNatural childbirth
dc.subjectPrivate
dc.subjectQuality improvement
dc.titleEvaluation of labor and childbirth care by nurse-midwives in Brazilian private hospitals: results of a quality improvement project
dc.typeArticle


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