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

Abstract

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.

Elaboration and implementation of a protocol for the Golden Hour of premature newborns using an Implementation Science lens

“…The data after implementation of the protocol revealed advances such as reduction in the hypothermia rate on admission, as well as an increase in capillary blood glucose levels and in the glucose solution supply in the first hour of life. A research study conducted in two Brazilian hospitals verified successful results in preventing hypothermia in very low birth weight preterm infants, using standardization of care in the delivery room and team training ( 7 ) . International studies report improvements in PTNB glycaemic and temperature control after implementation of the Golden Hour Protocol ( 3 - 6 , 10 , 23 ) , supporting the results of this study.…”

“…The effective integration of evidence-based interventions into neonatal care, including adoption of advanced technologies have contributed to a significant reduction in neonatal morbidity and mortality rates globally (1)(2) . Implementation settings which focus on continual improvements in quality have the potential for continually better survival outcomes in PTNBs (3)(4)(5)(6)(7)(9)(10)(11) .…”

“…A number of studies have already shown the positive impact of implementing Golden Hour protocols in the prevention and reduction of hypothermia and hypoglycemia rates in the care of preterm newborns (PTNBs) through standardization of care ( 1 , 6 - 7 ) . Offering assistance informed by scientific evidence, the Golden Hour protocols contribute to the systematic use of effective interventions, standardization of clinical practices across providers and settings and rational organization of services, as well as contribute to professionals’ ethical awareness ( 1 , 3 , 8 - 9 ) .…”

Prevalence and Factors Associated With Breastfeeding in the First Hour of Life: A Cross-Sectional Study

“…Thus, in addition to contributing to the bond between mother and child, skin-to-skin contact can promote an early initiation of breastfeeding by increasing oxytocin levels 8,22 . Routine neonatal care and transfer to the recovery room are well-known interferences that are associated with a shorter duration of skin-to-skin contact than that recommeded 23 . It is known that both the woman's primary social network (people closer to her and more involved) and secondary social network (health professionals) may favor her contact with the newborn after birth and thereby lead to more successful breastfeeding 8,21,24 .…”

Prevalência E Fatores Associados À Amamentação Na Primeira Hora De Vida: Estudo Transversal

“…Dessa forma, além de contribuir para o vínculo entre mãe e filho, o contato pele a pele pode favorecer o início precoce da amamentação por elevar os níveis de ocitocina 8,22 . Os cuidados neonatais de rotina e a transferência para a sala de recuperação são conhecidas interferências para o contato pele a pele em tempo inferior ao preconizado 23 . Sabe-se que tanto a rede social primária (pessoas próximas e mais envolvidas) como secundária (profissionais de saúde) da mulher podem favorecer o contato com o RN após o nascimento e, assim, levar à amamentação mais bem sucedida 8,21,24 .…”