- 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.
- 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.
- 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.
- Deliveries were not risk-stratified.