Abstract
This article aims to describe the preliminary results of two evaluations studies, one about the Stork Network program and the other about the Adequate Birth program, called Stork Network Assessment and Healthy Birth, and to identify possible improvements in comparison to the Birth in Brazil study. Both studies used a cross-sectional design and were conducted in 2017. The Stork Network Assessment study included all 606 public and mixed maternity hospitals from the Stork Network and a total of 10,675 postpartum women. The Healthy Birth study included a convenience sample of 12 private hospitals and 4,798 women. Indicators of labour and childbirth care were: presence of a companion person, care by obstetric nurse, use of partograph, use of non-pharmacological methods, walking during labor, eating, use of peripheral venous catheter, position for delivery, episiotomy, and Kristeller maneuver. The indicators were compared to those verified in Birth in Brazil, a nationwide population-based study in 2011-2012, before the start of the two intervention programs. Comparisons used the chi-square test for independent samples and 95% confidence interval. There was a significant increase in the number of women with access to appropriate technology for labour and childbirth from 2011 to 2017 and a reduction in harmful practices. The private sector also showed a decrease in cesarean rates and an increase in gestational age at birth. The study's results show that properly conducted public policies can change the scenario of care for labor and childbirth, helping to reduce in negative maternal and neonatal outcomes.
Highlights
Brazil presents a model of labour and birth care that is characterized by the excessive use of obstetric and neonatal interventions 1,2
All hospital directors and postpartum women underwent a prior consent visit and subsequently signed an informed consent form. In both 2017 studies (Stork Network Assessment and Healthy Birth), we observed a higher proportion of women of ≥35 years of age, with a higher level of schooling, who declared themselves black and white and that were primiparous, when compared to the two groups of women from Birth in Brazil study (Table 1)
There was a reduction in the rates of antepartum caesarean section, which resulted in an increase in intrapartum caesarean section, with a 50% increase in the public sector and a 136% increase in the private sector (5.5% to 13%)
Summary
Brazil presents a model of labour and birth care that is characterized by the excessive use of obstetric and neonatal interventions 1,2. These interventions, either when used routinely or when they are not based on scientific evidence, are associated with unfavourable maternal and perinatal outcomes 3,4,5,6,7. Actions were taken to increase and improve reproductive and prenatal planning, focusing on humanized care during pregnancy, childbirth and the puerperium period. This strategy promoted an increase in the offer of residency and specialization courses in field of woman and child’s health, especially for obstetric nursing. More than 600 public (or Brazilian Unified National Health System – SUS-related) maternity hospitals were involved in this process
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