Incorporating innovations in childbirth and newborn care: a pilot intervention of the Mother-baby Friendly Birthing Facility (MBFBF) Initiative

Background, including element of originality In recent years, many innovations have been proposed in perinatal health to make it safer, more women-friendly and evidence-based. Despite public policies and consumers pressure... [ view full abstract ]

Background, including element of originality

In recent years, many innovations have been proposed in perinatal health to make it safer, more women-friendly and evidence-based. Despite public policies and consumers pressure for change and humanization of childbirth, incorporation of innovations has been slow. In 2015, international agencies launched the Mother-Baby Friendly Birthing Facility Initiative (MBFBF) to address these problems.

Methods

Qualitative component of a quasi-experimental, mixed methods intervention, with before and after assessment, in a public maternity training hospital in São Paulo, Brazil. Documental analysis, observation of care, interviews and focal groups were conducted, to help designing the intervention, exploring how providers, managers and women perceive inadequacies in maternity care, and opportunities for change.  

Results

According to respondentes, these major issues are hindering the incorporation of innovations: (1) a history of receiving single, destitute pregnant women, supposed to endure humilliation; (2) structural problems leading to lack of privacy during labor and childbirth; (3) poorly regulated access to women in labor by medical and nursing students, for training purposes; (4) lack of appropriate control of potentially harmful and painful interventions; (5) women could not identify providers in charge of them (lack of accountability); (6) obstacles for companionship during all hospital stay; (7) absence in providers’s training of a culture of informed choice, consent or refusal; (8) women’s feelings of discrimination for routines (ex. mandatory shower before admission);

Discussion

Mapping institutional culture and structural problems, with definition of priorities and indicators for change added unantecipated themes and priorities. The formative phase itself ignited changes in routines, before intervention itself.

Conclusion

Involving the stakeholders in defining priorities enhanced their sense of ownership,  helped design, enhanced the intervention and proposed unantecipated strategies.

Statement on ethical matters related to the study.

Ethical approval by the School of Public Health Ethical Committee

Statement on funding source for the study

Funded by São Paulo State Research Foundation (FAPESP)

Statement that results will be presented at the conference

Results will be presented at the conference

Preferred presentation mode: 

Oral.