Barriers to implementing guideline recommendations to improve childbirth care: a rapid review of evidence

Abstract

Objectives. To identify potential barriers to the implementation of the National Childbirth Guidelines in Brazil based on the best available global evidence. Methods. A rapid review of evidence was performed in six databases in March/April 2019. Secondary studies published in English, Spanish, or Portuguese with a focus on barriers of any nature relating to the implementation of the Guidelines were retrieved. Results. Twenty-three documents (21 reviews and two practice guides) were included in the review. The barriers identified were grouped into 52 meaning categories and then reorganized into nine thematic clusters: delivery and childbirth care model, human resource management, knowledge and beliefs, gender relations, health care service management, attitudes and behaviors, communication, socioeconomic conditions, and political interests. Conclusions. The results show that combined approaches may be required to address different barriers to the implementation of the Guidelines. For successful implementation, it is essential to engage health care leaders, professionals, and users in the effort to change the delivery and childbirth care model. Also necessary is the development of intersectoral initiatives to improve the socioeconomic conditions of women and families and to curtail gender inequalities.

Women’s preference for a vaginal birth in Brazilian private hospitals: effects of a quality improvement project

“…To reduce unnecessary cesarean sections, strategies directed at women must be linked to other interventions aimed at health professionals and the hospital environment, including social support, assistance by nurse-midwives/midwives, the training of health care providers and implementation of evidence-based clinical guidelines [ 17 , 54 , 55 ]. Changes in the childbirth model of care, aiming at a more positive experience for women, are fundamental for future choices, due to the importance of previous experiences when choosing the type of birth in new pregnancies [ 17 , 25 , 41 , 42 , 46 ].…”

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

“…In general, there was an improvement in the records of the care provided in the first hour of the PTNBs by the professionals after implementing the protocol. The use of protocols based on the best evidence, adapted to the local context and implemented by a trained team with good communication, can reduce variability of the actions, promote safety, improve the birth experience and reduce unnecessary procedures ( 3 - 6 , 24 ) . When evaluating the implementation, training was the main cited facilitator, while team adherence, mainly from other sectors, and lack of knowledge were the most cited barriers.…”

Strengths-based Nursing and Healthcare in maternities: rethinking practices and continuity of care

“…Studies present assistance focused on meeting the pregnant woman's health problem with little consideration regarding their doubts, wishes, feelings, and beliefs, and it is noticeable that health care in a humanized and welcoming way has not yet reached the level recommended by national and international guidelines (12)(13)(14) .…”

“…The prescriptive posture of nurses and the hierarchical relationship were examples of care based on deficits, in the reality studied. In obstetric care, the authoritarian structure of health professionals, specialists, legitimized over the years, provides a privileged position of power in the relationship with women, interfering with their autonomy and the care provided (12)(13)(14) .…”