BackgroundIn Brazilian private hospitals, caesarean section (CS) is almost universal (88%) and is integrated into the model of birth care. A quality improvement intervention, “Adequate Birth” (PPA), based on four driving components (governance, participation of women and families, reorganisation of care, and monitoring), has been implemented to help 23 hospitals reduce their CS rate. This is a protocol designed to evaluate the implementation of PPA and its effectiveness at reducing CS as a primary outcome of birth care.MethodsCase study of PPA intervention conducted in 2017/2018. We integrated quantitative and qualitative methods into data collection and analysis. For the quantitative stage, we selected a convenient sample of twelve hospitals. In each of these hospitals, we included 400 women. This resulted in a total sample of 4800 women. We used this sample to detect a 2.5% reduction in CS rate. We interviewed managers and puerperal women, and extracted data from hospital records. In the qualitative stage, we evaluated a subsample of eight hospitals by means of systematic observation and semi-structured interviews with managers, health professionals and women. We used specific forms for each of the four PPA driving components. Forms for managers and professionals addressed the decision-making process, implemented strategies, participatory process in strategy design, and healthcare practice. Forms for women and neonatal care addressed socio-economic, demographic and health condition; prenatal and birth care; tour of the hospital before delivery; labour expectation vs. real experience; and satisfaction with care received. We will estimate the degree of implementation of PPA strategies related to two of the four driving components: “participation of women and families” and “reorganisation of care”. We will then assess its effect on CS rate and secondary outcomes for each of the twelve selected hospitals, and for the total sample. To allow for clinical, socio-demographic and obstetric characteristics in women, we will conduct multivariate analysis. Additionally, we will evaluate the influence of internal context variables (the PPA driving components “governance” and “monitoring”) on the degree of implementation of the components “participation of women and families” and “reorganisation of care”, by means of thematic content analysis. This analysis will include both quantitative and qualitative data.DiscussionThe effectiveness of quality improvement interventions that reduce CS rates requires examination. This study will identify strategies that could promote healthier births.Electronic supplementary materialThe online version of this article (10.1186/s12978-018-0636-y) contains supplementary material, which is available to authorized users.

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.

Pesquisa qualitativa, que objetivou analisar os sentidos atribuídos pelas enfermeiras às mudanças de sua prática obstétrica, utilizando o método produção de sentidos no cotidiano - práticas discursivas, proposto por Mary Spink. Dados coletados por entrevista individual, semiestruturada, com 16 enfermeiras obstétricas, em maternidades públicas - Rio de Janeiro, Brasil. Foram analisadas com os conceitos de travessia de fronteiras e constelações de poder de Boaventura Santos. Os sentidos atribuídos pelas enfermeiras às práticas obstétricas evidenciaram uma transformação em processo no âmbito do conhecimento obstétrico e das práticas na perspectiva da desmedicalização. Fronteira, lugar de transição paradigmática de novas práticas surge em relações emancipatórias com as mulheres. Concluímos que experimentar novas práticas envolve superação dos limites conhecidos para encontrar autonomia, configurando-se um conhecimento e prática com possibilidades emancipatórias. Travessias, nessa direção, se dão pela ousadia de buscar e experimentar o novo, transgredir o limite e aproveitar os espaços abertos na constelação de poderes.

Trata-se de uma pesquisa quantitativa que teve como objetivo analisar a assistência pré-natal oferecida pela Casa de Parto David Capistrano Filho (RJ) sob a ótica de suas usuárias e baseou-se no conceito de Humanização do Parto e Nascimento. Para tanto, foram convidadas a responder o questionário todas as puérperas que tiveram seus partos entre os meses de maio e setembro de 2005. Os resultados obtidos nos informam que esta maneira diferenciada de assistência vem sendo bem aceita pela população assistida, além de oferecer os serviços e cuidados preconizados pelo Ministério da Saúde, seguindo as normas da Organização Mundial de Saúde de atenção segura e efetiva à gestação e parto de baixo risco.