Obstetric interventions in a maternity hospital with a collaborative model of care: a comparative observational study.

Collaborative models (CM) focused on intrapartum care shared between both midwives and obstetricians have been proposed as a strategy to reduce these rates. Our aim was to compare use of evidence-based practices, obstetric interventions and c-section rates in two settings: a maternity hospital that applies a CM of care (MRJ) and data from a pool of maternity hospitals included in the Birth in Brazil Survey (NB) that do not adopt a CM. Data was abstracted from medical and administrative records in MRJ and from medical records and face-to-face interviews in NB. Differences were compared using chi-square test, with significance level set at p<0.05. MRJ showed a higher frequency of labour companionship, labour care provided by nurse midwives, non-pharmacological pain relief methods, food intake during labour, and less use of oxytocin, analgesia and amniotomy. More women also had second stage assisted by a nurse midwife and in a vertical position, as well as lower use of episiotomies and vacuum-extractor/forceps. The c-section rate was lower at MRJ. Shared care between midwives and obstetricians can be an effective strategy to improve quality of intrapartum care.

Obstetric interventions in a maternity hospital with a collaborative model of care: a comparative observational study / Intervenções obstétricas em uma maternidade com modelo colaborativo: estudo observacional comparativo

Abstract Collaborative models (CM) focused on intrapartum care shared between both midwives and obstetricians have been proposed as a strategy to reduce these rates. Our aim was to compare use of evidence-based practices, obstetric interventions and c-section rates in two settings: a maternity hospital that applies a CM of care (MRJ) and data from a pool of maternity hospitals included in the Birth in Brazil Survey (NB) that do not adopt a CM. Data was abstracted from medical and administrative records in MRJ and from medical records and face-to-face interviews in NB. Differences were compared using chi-square test, with significance level set at p<0.05. MRJ showed a higher frequency of labour companionship, labour care provided by nurse midwives, non-pharmacological pain relief methods, food intake during labour, and less use of oxytocin, analgesia and amniotomy. More women also had second stage assisted by a nurse midwife and in a vertical position, as well as lower use of episiotomies and vacuum-extractor/forceps. The c-section rate was lower at MRJ. Shared care between midwives and obstetricians can be an effective strategy to improve quality of intrapartum care.

Resumo Modelos colaborativos (MC) com foco no cuidado intraparto compartilhado entre parteiras e obstetras têm sido propostos como uma estratégia para reduzir essas taxas. Nosso objetivo foi comparar o uso de práticas baseadas em evidências, intervenções obstétricas e taxas de cesarianas em dois ambientes: uma maternidade que aplica um MC de atendimento (MRJ) e dados de um conjunto de maternidades incluídas na pesquisa Nascer no Brasil (NB) que não adotam um MC. Os dados foram extraídos de prontuários médicos e documentos administrativos no MRJ e de prontuários e entrevistas presenciais em NB. As diferenças foram comparadas pelo teste do qui-quadrado, com nível de significância estabelecido em p<0,05. MRJ apresentou maior frequência de acompanhante no parto, assistência ao parto por enfermeiras obstétricas, métodos não farmacológicos de alívio da dor, ingestão de alimentos durante o trabalho de parto e menor uso de ocitocina, analgesia e amniotomia. Mais mulheres também tiveram o parto assistido por enfermeira obstétrica e em posição vertical, bem como menor uso de episiotomias e vácuo-extrator/fórceps. A taxa de cesariana foi menor no MRJ. O cuidado compartilhado entre enfermeiras e obstetras pode ser uma estratégia eficaz para melhorar a qualidade do cuidado intraparto.