Measuring harm-free care in childbirth: a pilot application of the maternity safety thermometer in Brazil

Abstract

Introduction: In Brazil, interventions during labor and childbirth are harmful and, for the most part, unnecessary. In addition, there is a high prevalence of abuse and disrespect for women and babies during this period. Objective: To describe the prevalence of maternal and neonatal harm and harm-free care in a Brazilian maternity setting. Methods: Pilot application of the Portuguese version of Maternal Safety Thermometer (MST) by a cross-sectional study in a public setting. Data collection was made at two timepoints. Results: 140 women were included. Over 84% of women had a postpartum sutured wound, resulting from a caesarean section, an episiotomy, or a perineal trauma. Puerperal infection, especially on a caesarean wound, was the most frequent physical harm. Women’s perception of safety, including being left alone in labour, and feeling their safety concerns were not taken seriously, decreased from 80.6% to 43.3% in the second timepoint. Using the MST helped to improve the quality of medical records since critical information about a patient’s health status was not properly recorded, or even absent. Conclusion: MST is a concise tool and includes indicators related to harm-free care in a short time range. However, this study suggests that the MST can underestimate harm if it is used alone to assess harm-free care in maternities with excessive levels of intervention, and poor reporting of harms (i.e., blood loss), as in most Brazilian settings.

Complexity theory in the management of patients with pain

“…For this reason, it is important to consider the approach to the patient with pain as a CS since it will offer additional therapeutic opportunities to manage pain and could be essential to improve the therapeutic efficacy of different interventions. In this approach, the Journal of Human Growth and Development (JHGD) brings to each edition discussions [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] , which can be enriched with this debate about CF and CS in different health conditions and epidemiological contexts.…”