Care at the first postnatal hour in two hospitals of the Adequate Birth Project: qualitative analysis of experiences in two stages of the Healthy Birth research.

BACKGROUND:  The Adequate Childbirth Project (PPA) is a quality improvement project that aims to enhance normal delivery and reduce cesarean sections with no clinical indication in the Brazilian supplementary health care system. This study aims to analyze the care model of the first postpartum hour in hospitals that participated in the PPA. METHODS: Qualitative analysis based on the narrative of 102 women attended at two hospitals participating in the evaluative "Healthy Birth" research that analyzed the degree of implementation and the effects of the PPA. We assessed three practices within the first hour after delivery: skin-to-skin contact, breastfeeding and appropriate clamping of the umbilical cord. Data was collected through semi-structured interviews by telephone and submitted to thematic content analysis. RESULTS: The categories that emerged from the analysis of the results were "Dimension of time and care expressed in the lived experience" and "Interferences in care in the first hour of life". In the first category, women reported that in the first hour after delivery the newborn was placed on the mother's chest, but the length of time of the newborn's stay in skin-to-skin contact was less than one hour. This experience, even in a shorter period of time, was said to be positive by the women interviewed. Two barriers were observed: interruption of skin-to-skin contact for neonatal care and the transfer to the recovery room, both separating baby from mother without observing the duration of the "golden hour". It was identified that a process of improvement of the quality of care for childbirth is underway, with a gradual incorporation of recommended practices for care in newborn's first hour of life. CONCLUSIONS: Women reported access to the three care practices at two hospitals participating in the PPA quality improvement project. All practices were valued by women as a positive experience and should be promoted. Information during antenatal care to increase women´s autonomy, review of hospital practices to reduce barriers, and support from health care providers during the first hour after birth are needed to improve the implementation of these practices and access to their health benefits.

This study aims to analyze the care model of the first postpartum hour offered by two hospitals participating in the Adequate Childbirth Project (PPA), a quality improvement project to enhance normal delivery and reduce unnecessary cesarean sections in Brazilian private hospital. It is a qualitative analysis, based on the narrative of 102 women attended at two hospitals participating in the PPA. Categories that emerged from the analysis: "First hour; dimension of time and care expressed in the lived experience" and "Interferences in care in the first hour of life". Most women expressed a chronological time of skin-to-skin contact far from the ideal recommended in the first postpartum hour; however, they valued the experience and its meaning. Two barriers were observed in this care process: the interruption of skin-to-skin contact for neonatal care and the transfer to the recovery room, without observing the duration of the "golden hour". We can conclude that women evaluated the service positively, with indications that point to the sustainability of the PPA. Information during antenatal care to increase women´s autonomy are needed to improve the implementation of these practices and access to their health benefits.

Women's voice on changes in childbirth care practices: a qualitative approach to women's experiences in Brazilian private hospitals participating in the Adequate Childbirth Project.

BACKGROUND: In Brazil, childbirth practices are strongly marked by surgical events and particularly in the private sector cesarean sections reach rates above 80%. The National Supplementary Health Agency proposed the Adequate Childbirth Project (PPA), a quality improvement project developed at Brazilian hospitals with the aim of changing the current model of childbirth care and reducing unnecessary cesarean sections. The objective of this study is to assess how the participation of women in the process of improving quality childbirth care occurred in two hospitals participating in the PPA. METHOD: Qualitative study, based on interviews with 102 women attended at two hospitals that took part in the first and second stages of the "Healthy Birth", an evaluative hospital-based research, conducted in 2017-2018, that assessed the degree of implementation and the effects of PPA. After thematic content analysis, supported by MaxQda software, three categories emerged: (1) how women gathered knowledge about the PPA, (2) how women perceived it, and (3) which are their suggestions for the PPA improvement. RESULTS: The PPA was unknown to most women before delivery. A polysemy of terms, including adequate childbirth, promotes recognition of the "new" model of care. Visits to the maternity hospital and antenatal care groups for pregnant women are opportunities for contacts that change the perception of what childbirth can be. Women have expectations of a relationship with maternity that is not limited to the moment of delivery. The listening channels established between hospitals and women are fragile and not systematized. By increasing the supply of listening spaces, one can also increase the request to leave their suggestions and contributions, and thus gain more allies in improving the project. Women are not yet included as PPA agents and their voices are silenced. CONCLUSIONS: Women's participation to improve childbirth care is relevant and necessary. The women's voice in the PPA is still incipient, and maternity hospitals and health plan operators should create strategies to insert and engage them. Women's voices should be listened to not only during but also before and after childbirth.

In Brazil, childbirth practices are strongly marked by surgical events and particularly in the private sector cesarean sections reach rates above 80%. The Adequate Childbirth Project (PPA) is a quality improvement project developed at Brazilian hospitals with the aim of changing the current model of childbirth care and reducing unnecessary cesarean sections. A qualitative study was developed in order to understand how hospitals have included the participation of women in the PPA. Based on interviews with 102 women, the present study shows that the PPA was unknown to most women before delivery. A polysemy of terms, including adequate childbirth, promotes recognition of the "new" model of care. Visits to the hospital and antenatal care groups for pregnant women are opportunities for contacts that change the perception of what childbirth can be. Women's participation to improve childbirth care is relevant and necessary. The women's voice in the PPA is still incipient and women are not yet included as agents of change, and their voices are silenced. Hospitals and health plan operators should create strategies to engage them. Women's voices may be listened to not only during but also before and after childbirth.