ArticleObstetrics and gynecology2020
A Quality Improvement Initiative to Increase the Frequency of Vaginal Delivery in Brazilian Hospitals.
Article in Obstetrics and gynecology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed, 52 citations in OpenAlex.
- Knowledge, attitudes and practices of Brazilian obstetricians in relation to childbirth care.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Financial and regulatory interventions to reduce unnecessary caesarean sections: An updated scoping review.PLOS global public health · 2026Article
- A Comprehensive Strategy to Mitigate Institutional Maternal Mortality: Lessons From a Quality Improvement Initiative in Brazilian Maternity Hospitals.Global health, science and practice · 2025Article
- Pregnancy, childbirth, and birth in the state of Rio de Janeiro.Revista de saude publica · 2025Article
- Quality improvement collaborative to increase access to caesarean sections: lessons from Bihar, India.BMJ quality & safety · 2025Article
- Effect of a multifaceted intervention with audit and feedback on low-risk childbirth practice: a multicentre prospective study.BMC pregnancy and childbirth · 2025Article
- Reducing caesarean section rates in Robson groups 1 and 3: a quality improvement initiative in a private Brazilian hospital.BMJ open quality · 2025Article
- Inequalities in the care for Labor and Delivery in Rio de Janeiro - Birth in Brazil Research II: national survey on abortion, delivery, and birth.Revista de saude publica · 2025Article
- The effects of a quality improvement project to reduce caesarean sections in selected private hospitals in Brazil.Reproductive health · 2024Article
- Association between the Dietary Inflammatory Index and the Risk of Cesarean Delivery.Iranian journal of public health · 2024Article
- An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals.Reproductive health · 2024Article
- Women's preference for a vaginal birth in Brazilian private hospitals: effects of a quality improvement project.Reproductive health · 2024Article
- Appropriate Delivery Project: Impact of Simulation Training on the Increase in Vaginal Births in Hospitals in Brazil.Einstein (Sao Paulo, Brazil) · 2024Observational
- Educational interventions targeting pregnant women to optimise the use of caesarean section: What are the essential elements? A qualitative comparative analysis.BMC public health · 2023Article
- Impact of an intrapartum care quality improvement intervention in Brazilian private hospitals on care safety measures and adverse outcomes.Reproductive health · 2023Article
- Women's voice on changes in childbirth care practices: a qualitative approach to women's experiences in Brazilian private hospitals participating in the Adequate Childbirth Project.Reproductive health · 2023Article
- Evaluation of labor and childbirth care by nurse-midwives in Brazilian private hospitals: results of a quality improvement project.Reproductive health · 2023Article
- Care at the first postnatal hour in two hospitals of the Adequate Birth Project: qualitative analysis of experiences in two stages of the Healthy Birth research.Reproductive health · 2023Article
- Breastfeeding in the first hour of life in Brazilian private hospitals participating in a quality-of-care improvement project.Reproductive health · 2023Article
- Interventions targeting healthcare providers to optimise use of caesarean section: a qualitative comparative analysis to identify important intervention features.BMC health services research · 2022Article
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
Abstract
objectiveTo evaluate a quality improvement (QI) initiative designed to increase the frequency of vaginal delivery in Brazilian hospitals.
methodsTwenty-eight hospitals enrolled in a 20-month (May 2015-December 2016) Breakthrough Series Collaborative that used QI methods to increase implementation of obstetric approaches with potential to increase the frequency of vaginal delivery. All hospitals contributed qualitative data for iterative redesign. Thirteen intervention hospitals with complete data contributed to an analysis of changes in vaginal delivery in a targeted population over time. Hospitals from the São Paulo region (five intervention and eight nonintervention) contributed to a comparator analysis of changes in vaginal delivery for all deliveries over time.
interventionMost hospitals targeted low-risk pregnancies in primiparous women, delivered by hospital-employed obstetricians or admitted through emergency departments, and some included all pregnant women. The collaborative tested four interventions to increase vaginal delivery: 1) coalition building of stakeholders with the common purpose of ensuring "appropriate delivery," 2) empowering pregnant women to choose their preferred mode of delivery, 3) implementation of new care models favoring physiologic birth, and 4) improved information systems for continuous learning by health care providers.
resultsFor 119,378 targeted deliveries (36% of all deliveries) in 13 intervention hospitals, vaginal delivery increased from 21.5% in 2014 to 34.8% in 2016, a relative increase of 1.62 (95% CI 1.27-2.07, P<.001). In the comparator analysis, vaginal delivery for all deliveries in the five São Paulo intervention hospitals increased from 16.1% to 23% (RI 1.43, P<.001) and from 11.0% to 13.0% (relative rate ratio 1.18, P<.001) in the eight nonintervention São Paulo hospitals. The relative increase in vaginal delivery between the São Paulo intervention and nonintervention groups was 1.21 (95% CI 1.05-1.41, P=.01). The rate of maternal adverse events and neonatal intensive care unit admissions for newborns who weighed at least 2,500 g did not differ significantly during the observation period.
conclusionsKey interventions implemented with QI methods were associated with increased vaginal delivery. This approach may help address the global cesarean delivery epidemic.
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