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

Abstract

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.

CAESAREAN DELIVERY ON MATERNAL REQUEST: the perspective of the postpartum women

“…Caesarean delivery on maternal request (CDMR) is a trend, following a movement to give a voice and guarantee the women's right to choose. (1,2). However, C-section exposes the pregnant woman and her fetus to health risks if unnecessary (3).…”

“…Worldwide, CDMR accounts for a growing proportion of caesarean births, estimated to range from 0.2-42% of all C-sections, varying according to the sociodemographic characteristics of the women and the care pro le of the maternity service where the birth takes place (4). In Brazil, where the rate of C-section is 56%, varying from 40% in the public sector to 84% in the private sector, the proportion of CDMR is not known (2).…”

Caesarean delivery on maternal request: the perspective of the postpartum women

“…Cesarean delivery on maternal request (CDMR), defined by the American College of Obstetricians and Gynecologists (ACOG) as a primary cesarean section at maternal request, in the absence of any maternal or fetal indication, performed after 39 completed weeks of gestation or with verification of pulmonary maturity [ 1 ], is a trend, following a movement to give women a voice and guarantee their right to choose [ 2 , 3 ]. Despite the proven effectiveness of caesarean section in saving the life of the mother and/or fetus, in conditions where vaginal delivery is unsafe, performing a caesarean section exposes the pregnant woman and the fetus to health risks when it is unnecessary [ 1 ].…”