Which changes in OB care led to lower CD rates in Brazil?

  • Borem P & al.
  • Obstet Gynecol
  • 09/02/2020

  • Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Cesarean delivery (CD) rates were decreased in Brazil with targeted changes in obstetrical care.

Why this matters

  • Brazil had the highest CD rate worldwide in 2016, at 30%-40% in the public sector and 80%-90% in the private sector.
  • Quality improvement initiatives have been successfully used in the United States for CD reduction.
  • High CD rates are partly the result of cultural norms.

Key results

  • Percentage of vaginal deliveries increased after initiative: 23.0% vs 16.1% before (P<.001>
  • No change in neonatal ICU admissions (P=.27) or adverse events (P=.32) over the study period.
  • Changes in care because of the initiative included:
    • Physical change in design of birthing rooms,
    • Changes in style of birthing classes,
    • More inclusive obstetrical team,
    • Increased collection of data, and
    • Change in labor management to include a support person and support for physiologic birth.

Study design

  • Observational, comparative, longitudinal study.
  • Hospitals were called to participate in Project Parto Adequarto (Project Appropriate Birth) Collaborative based on Patient Safety Committee/Ministry of Health recommendations designed to reduce CD rates.
  • Changes in patient outcomes were compared between participating hospitals (n=13) and nonparticipating hospitals (n=8).
  • Primary outcome was percentage of vaginal deliveries.
  • Funding: Sociedade Beneficente Israelita Brasileira Albert Einstein.

Limitations

  • Deliveries were not risk-stratified.