Article type
Abstract
Background: In 2014, the c-section rate reached 84.4% of total deliveries in the Brazilian private health system. This excess is a public health problem, associated with the increase of maternal and neonatal morbidity and mortality (1) and with a possible long-term impact on the development of chronic diseases. The Brazilian prematurity rate in 2012 was 12.4% of all live births corresponding to 340 000 babies. Preterm birth is among the leading causes of child mortality before age 5 (2).
Objectives: To identify innovative and viable models of attention to childbirth and birth, which value normal childbirth and reduce the percentage of unnecessary c-sections. Provide women and babies with the right care, at the right time, during pregnancy, throughout labour and delivery, considering the structure and preparation of the multiprofessional team, evidence-based medicine, and sociocultural and affective conditions.
Methods: Parto Adequado (Appropriate Delivery) Project is a partenrship between Agencia Nacional de Saúde (ANS, regulatory agency), the Israelita Albert Einstein Hospital (HIAE) and the Institute for Healthcare Improvement (IHI), to develop an evidence-based programme including evidence-based implementation strategies, to be developed in several phases, initially with pilot studies, to finally result in a definitive intervention on the problem. Three models were proposed. Table 1
Results: Phase I participants: 19 health plans and 26 hospitals with pilot project. Among these, Amil Assistência Médica, Hospital da Luz and Hospital Pasteur respectively Health Plan and hospitals of United Health Group Brazil. In 18 months, more than 10 thousand c-sections without indication and 400 hospitalisations were avoided. Table 2
Conclusions: Based on the learning obtained in phase 1, ANS, IHI and HIAE launched Phase 2 of the project, which will be developed over two years, by 150 hospitals/maternities. UHG Brazil increased participation with 5 more hospitals besides the current ones and Amil.
References
1) Clark; Miller, Belfort, 2009
2) World Health Organization, 2015
Objectives: To identify innovative and viable models of attention to childbirth and birth, which value normal childbirth and reduce the percentage of unnecessary c-sections. Provide women and babies with the right care, at the right time, during pregnancy, throughout labour and delivery, considering the structure and preparation of the multiprofessional team, evidence-based medicine, and sociocultural and affective conditions.
Methods: Parto Adequado (Appropriate Delivery) Project is a partenrship between Agencia Nacional de Saúde (ANS, regulatory agency), the Israelita Albert Einstein Hospital (HIAE) and the Institute for Healthcare Improvement (IHI), to develop an evidence-based programme including evidence-based implementation strategies, to be developed in several phases, initially with pilot studies, to finally result in a definitive intervention on the problem. Three models were proposed. Table 1
Results: Phase I participants: 19 health plans and 26 hospitals with pilot project. Among these, Amil Assistência Médica, Hospital da Luz and Hospital Pasteur respectively Health Plan and hospitals of United Health Group Brazil. In 18 months, more than 10 thousand c-sections without indication and 400 hospitalisations were avoided. Table 2
Conclusions: Based on the learning obtained in phase 1, ANS, IHI and HIAE launched Phase 2 of the project, which will be developed over two years, by 150 hospitals/maternities. UHG Brazil increased participation with 5 more hospitals besides the current ones and Amil.
References
1) Clark; Miller, Belfort, 2009
2) World Health Organization, 2015