Healthy birth: a prospective study to assess the introduction and effects of a multifaceted intervention to improve the quality of care during childbirth and birth in hospitals in Brazil

The research evaluated the impacts of the Adequate Childbirth program, developed by ANS and Albert Einstein Hospital and already implemented in 143 private hospitals in Brazil, in order to reduce unnecessary cesarean sections and encourage quality vaginal delivery.

The study looked at twelve hospitals participating in the Adequate Childbirth program. In each of them, the researcher interviewed approximately 400 women who had their babies in these selected institutions, for a total of 4,800 interviews. Among the questions asked were those that tried to evaluate the quality of care as a whole, the practices adopted at the time of delivery and the type of delivery: cesarean or normal.

The study found decreases in cesareans that ranged from 4.5% to 19.5% depending on the hospital, for an average of 10%. They also found a 10% reduction in so-called early term newborns — babies born between 37 and 38 weeks, just below the 39-40 weeks, which is considered ideal. These births are closely associated with scheduled caesarean sections.

It is the first time in Brazil that a program focused on reducing cesarean sections in private hospitals was evaluated in an independent study.

Improvement of the vaginal delivery procedure, with higher quality care and comfort for pregnant women. As a result, the program reduces excess cesarean sections performed in private hospitals in Brazil. In these institutions, nine out of ten births are due to surgical interventions, which accounted for 55% of births across the country in 2018.

The study found that the program effectively reduced unnecessary cesarean sections and, by ensuring a higher quality of care for pregnant women during childbirth, provides evidence to support its expansion to other private hospitals and health insurance operators in the country. It could also be offered in public hospitals.

With the necessary adaptations, the program can be effective in other countries that face high rates of unnecessary cesarean sections.

The research group organized the publication of a thematic issue in the scientific journal “Reproductive Health” for 2021, with 12 articles using data from this study. The issue will include detailed results from the analyses, including the implementation of the intervention components, existing barriers, and impact on puerperal women and newborns, considering maternal characteristics and risk factors. In addition, the issue will include an analysis of cost-effectiveness and sustainability of the intervention and research on the satisfaction of women who participated in the program.