Faculty of Nursing, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.
Anna Nery School of Nursing, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
Reprod Health. 2024 Apr 17;20(Suppl 2):189. doi: 10.1186/s12978-024-01772-7.
The "Adequate Childbirth Program" (PPA) is a quality improvement project that aims to reduce the high rates of unnecessary cesarean section in Brazilian private hospitals. This study aimed to analyze labor and childbirth care practices after the first phase of PPA implementation.
This study uses a qualitative approach. Eight hospitals were selected. At each hospital, during the period of 5 (five) days, from July to October 2017, the research team conducted face to face interviews with doctors (n = 21) and nurses (n = 28), using semi-structured scripts. For the selection of professionals, the Snowball technique was used. The interviews were transcribed, and the data submitted to Thematic Content Analysis, using the MaxQda software.
The three analytical dimensions of the process of change in the care model: (1) Incorporation of care practices: understood as the practices that have been included since PPA implementation; (2) Adaptation of care practices: understood as practices carried out prior to PPA implementation, but which underwent modifications with the implementation of the project; (3) Rejection of care practices: understood as those practices that were abandoned or questioned whether or not they should be carried out by hospital professionals.
After the PPA, changes were made in hospitals and in the way, women were treated. Birth planning, prenatal hospital visits led by experts (for expecting mothers and their families), diet during labor, pharmacological analgesia for vaginal delivery, skin-to-skin contact, and breastfeeding in the first hour of life are all included. To better monitor labor and vaginal birth and to reduce CS without a clinical justification, hospitals adjusted their present practices. Finally, the professionals rejected the Kristeller maneuver since research has demonstrated that using it's harmful.
“适当分娩计划”（PPA）是一个质量改进项目，旨在降低巴西私立医院不必要剖宫产率居高不下的问题。本研究旨在分析实施 PPA 第一阶段后分娩和分娩护理实践。
本研究采用定性方法。选择了 8 家医院。在每家医院，研究团队于 2017 年 7 月至 10 月期间，在为期 5 天的时间里，对医生（n=21）和护士（n=28）进行了面对面的访谈，使用半结构化脚本。在选择专业人员时，使用了滚雪球技术。对访谈进行了转录，并使用 MaxQda 软件对数据进行了主题内容分析。
护理模式变化过程的三个分析维度：（1）护理实践的纳入：理解为自 PPA 实施以来已纳入的实践；（2）护理实践的适应：理解为 PPA 实施前实施的实践，但随着项目的实施，这些实践发生了变化；（3）护理实践的拒绝：理解为那些被医院专业人员放弃或质疑是否应实施的实践。
PPA 之后，医院和对待女性的方式发生了变化。分娩计划、由专家（为孕妇及其家属）领导的产前医院就诊、分娩期间的饮食、阴道分娩的药物镇痛、皮肤接触和生命最初一小时内的母乳喂养都包括在内。为了更好地监测分娩和阴道分娩，并减少无临床依据的剖宫产，医院调整了目前的实践。最后，专业人员拒绝了克里斯泰勒手法，因为研究表明使用该手法会造成伤害。
