Assessment of adherence to best practices in labor and childbirth care by care providers working in public hospitals in the Federal District of Brazil

Carvalho, Elisabete Mesquita Peres de; Amorim, Fábio Ferreira; Santana, Levy Aniceto; Göttems, Leila Bernarda Donato

doi:10.1590/1413-81232018246.08412019

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ARTICLE • Ciênc. saúde colet. 24 (6) • June 2019 • https://doi.org/10.1590/1413-81232018246.08412019 copy

Assessment of adherence to best practices in labor and childbirth care by care providers working in public hospitals in the Federal District of Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To assess adherence to best practices in labor and childbirth care by doctors, nurses, obstetric nursing residents, and obstetric medical residents working in public hospitals in the Federal District of Brazil.

Method

A cross-sectional study was conducted with care providers working in 11 public hospitals in the Federal District of Brazil between January and March 2015. A questionnaire containing 20 sociodemographic questions and 50 five-point Likert items was administered. The average scores of each group and each hospital were analyzed.

Results

Nurses obtained the highest scores for the use of evidence-based practices (57.8 ± 12.9), while doctors achieved the highest scores for the work process dimension (72 ± 8.5). Medical residents obtained the highest scores for organization of labor and childbirth care (56.5 ± 8.5). No statistically significant differences were found between groups. Hospital scores ranged from 55 to 64. No statistically significant differences were found between hospitals. Most professionals encourage natural childbirth.

Conclusion

It is necessary to strengthen actions to promote greater adherence to best care practices, both in relation to organization of labor and childbirth care and to the attitudes and values of health professionals.

Keywords
Women’s health; Health knowledge, attitudes, and practices; Humanized childbirth; Health services research

Parameter	NUR (N = 83)	NUR-R (N = 28)	DOC (N = 116)	DOC-R (N = 34)	P-value
Average age, years (SD)	37.6 (8.5)	27 (7.3)	43 (8.7)	27 (1.9)
Average hours worked per week (SD)	39.2(12.7)	59.3(3.8)	40.7(15.7)	60.9(6.3)	< 0.01
Female, n (%)	74(89)	27(96.4)	73(63)	29(85.3)	< 0.01
Schooling, n(%)
Doctorate	0(0.0)	0(0.0)	2(1.7)	0(0.0)	< 0.01
Master’s	3(3.6)	1(3.6)	11(9.5)	0(0.0)
Specialist training course	58(69.8)	9(32.1)	102(87.9)	9(26.4)
Degree	22(26.5)	18(64.3)	1(0.8%)	25(73.5)
Encouraged normal childbirth among friends or family, n (%)	72(86.7)	28(100)	89(78.1)	31(91.2)	0.02

	NUR (N = 83) M(SD)	NUR-R (N = 28) M(SD)	DOC (N = 116) M(SD)	DOC-R (N = 34) M(SD)	P-value
I arrange a bed in another childbirth care center when there is no bed available in this service.	74.7(28.8)	64.3 (27.4)	70.7(29.0)	70.6(28.8)	NS(0.41)
I routinely receive mothers so they can familiarize themselves with the birth location.	67.5(38.7)	75.7(35.8)	33.3 (36.2)	27.0 (27.8)	< 0.01
Educational activities are carried out with mothers and companions at prior visits to promote maternal bonding.	67.2(32.5)	80.7(26.9)	59.6 (29.7)	55.3 (27.4)	0.02
We usually operate beyond the capacity of the maternity facility.	11.3(21.0)	17.9 (27.4)	6.4(16.1)	11.7(22.1)	0.04
The team is insufficient for the number of mothers seen daily.	11.1(23.0)	22.9(31.6)	11.0(22.3)	22.3(24.5)	NS(0.13)
It is easy to contact the primary care antenatal team and/or high-risk center when necessary.	43.6(25.8)	48.6(25.2)	44.5(27.4)	50.0(30.0)	NS(0.60)
I take part in antenatal team meetings to discuss improvement in antenatal and labor and childbirth care.	33.0(23.3)	50.0(32.9)	43.9(30.2)	47(25.5)	0.01
We experience difficulties in performing diagnostic and therapeutic support in other services when needed.	19.3(25.1)	27.1(21.9)	10.7(21.3)	25.3(28.8)	< 0.01
Electronic patient records facilitate access to information from other health centers.	72.5(27.2)	68.6(31.9)	71.4(27.5)	84.1(17.6)	NS(0.07)
Organization of labor and childbirth care	57.8(12.9)	53.8(12.5)	56(13.8)	57.6(12.5)	NS(0.52)

	NUR (N = 83) M(SD)	NUR-R (N = 28) M(SD)	DOC (N = 116) M(SD)	DOC-R (N = 34) M(SD)	P-value
Normal childbirth occurs on maternity bed in this service.	87.0(24.7)	95.7(15.7)	85.0(26.6)	94.1(9.2)	NS(0.62)
I routinely restrict oral fluid and food intake during labor.	48.4(29.3)	57.9(23.9)	54.3(28.4)	45.3(28.4)	NS(0.16)
I use curtains and/or dividers to ensure mother’s privacy during pre-labor.	79.8(29.0)	96.4(12.20	77.6(29.6)	94.1(11.6)	< 0.01
I encourage the mother to have a companion of her choice.	86.3(25.2)	90.7(23.4)	77.2(28.3)	85.3(23.3)	0.02
I recognize that companions hamper care procedures.	59.0(28.4)	73.6(18.9)	44.7(27.8)	47.6(26.1)	< 0.01
The companion is rarely informed of the mother’s status.	56.9(29.7)	59.3(24.6)	62.9(24.8)	60.0(23.1)	NS(0.45)
I give advice on relaxation techniques to help ease pain during labor and childbirth.	86.5(21.7)	97.9(6.3)	87.4(19.3)	85.9(19.4)	0.04
I encourage mobility during labor.	93.5(15.0)	99.3(3.8)	94.1(13.5)	95.9(8.2)	NS(0.18)
I use nonpharmacological pain management methods, such as massages and relaxation techniques.	78.1(24.9)	100.0(0.0)	68.4(27.6)	63.5(28.1)	< 0.01
I allow the mother to choose the position during labor and childbirth.	83.9(22.6)	100.0(0.0)	84.8(20.7)	80.0(23.1)	< 0.01
I routinely perform auscultation of the fetal heart every 30 minutes during active labor.	59.0(26.9)	90.0(14.9)	83.3(20.1)	83.5(17.4)	< 0.01
I use the partograph to monitor labor	50.4(30.0)	82.1(30.5)	60.3(31.5)	64.1(28.2)	< 0.01
I inform the mother of progress in labor.	84.8(23.5)	97.1(7.1)	94.7(13.3)	97.1(7.2)	< 0.01
I promote skin to skin contact in the first 30 minutes after birth.	90.1(19.3)	95.7(8.4)	93.3(14.9)	96.5(7.7)	NS(0.14)
I routinely perform routine enemas in pre-labor.	77.3(11.6)	80.0(0.0)	76.6(11.9)	75.3(12.1)	NS(0.38)
Perineal shaving is routinely performed in this service.	69.9(22.2)	72.1(21.3)	73.8(17.2)	64.7(24.6)	NS(0.13)
Intravenous rehydration is used during labor and childbirth.	21.2(20.8)	30.7(22.1)	32.1(26.2)	34.1(28.5)	0.01
Intravenous oxytocin is used to induce labor.	22.2(20.0)	26.4(21.1)	25.2(20.5)	29.4(24.2)	NS(0.37)
Pushing during the expulsion stage is encouraged.	15.7(22.3)	46.4(30.8)	9.0(15.5)	13.5(22.9)	< 0.01
Routine episiotomy is performed in this service.	31.6(25.4)	41.4(27.7)	49.0(26.3)	58.8(25.1)	< 0.01
I perform the Kristeller maneuver when necessary.	47.0(30.8)	74.3(18.7)	32.8(27.8)	45.3(31.3)	< 0.01
Best obstetric practices	56.3(7.1)	56.4(7.3)	56.5(8.5)	56.2(6.6)	NS(1.00)

	NUR (N = 83) M(SD)	NUR-R (N = 28) M(SD)	DOC (N = 116) M(SD)	DOC-R (N = 34) M(SD)	P-value
I follow ministry of health labor and childbirth care recommendations.	85.1(17.9)	95.0(10.4)	89.0(13.5)	93.5(9.5)	< 0.01
Mothers are informed before using interventions to accelerate labor.	72.8(28.4)	77.9(25.1)	91.9(12.1)	92.4(18.4)	< 0.01
Clinical decisions are shared among the shift team.	57.3(27.7)	60.0(24.9)	91.6(16.3)	92.9(10.9)	< 0.01
I discuss scientific evidence regarding labor and childbirth care with my team.	61.0(28.4)	82.1(22.0)	84.1(19.7)	86.5(15.4)	< 0.01
Doctors and nurses work in an integrated manner in this service.	60.7(27.5)	53.6(26.1)	81.0(19.9)	67.6(31.1)	< 0.01
Normal childbirth is encouraged by the multiprofessional team here.	73.7(26.7)	72.1(22.0)	91.0(14.3)	89.4(14.1)	< 0.01
Professionals in this service undertake periodic training.	48.0(24.8)	48.6(22.7)	65.2(24.8)	68.8(21.6)	< 0.01
Satisfaction surveys are conducted with users here.	30.8(19.3)	40.7(25.8)	45.2(23.0)	48.8(20.4)	NS(0.09)
Provision of childbirth care by nurses is restricted only to some shifts (rare).	21.7(29.0)	20.0(28.3)	27.1(27.6)	34.7(28.8)	NS(0.19)
Work process	67.4(15.6)	63.7(15.8)	68.2(15.2)	72.0(11.4)	NS(0.66)

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

EMP Carvalho and LBD Göttems worked on study conception and design, data collection, analysis and interpretation, and drafting this article; FF Amorim and LA Santana worked on data analysis, the critical revision of the article, and approved the final version to be published.