Improving infrastructure, data analysis, and working with pregnant women and doctors reduce caesarean deliveries in hospital networks; the country’s general index is on the rise
To cope with the high rate of unnecessary caesarean sections in the country, large networks of hospitals and private maternity hospitals have developed actions to restructure their facilities, train professionals and raise awareness among pregnant women about the benefits of I leave normal life and the risks of performing a caesarean section without clinical indication.
Courses for pregnant women with realistic simulations of childbirth, special rooms for labor with bathtub, pilates ball and even king size double bed, and training of multidisciplinary teams focused on the humanization of childbirth are some of the actions taken by health facilities to try to overcome the resistance of some doctors and patients to vaginal birth.
In Brazil, 57% of births in 2021 were by caesarean section and the rate has followed an upward trend in recent years. As revealed by Stage, the year 2020 recorded a record rate for this type of delivery. In the private network, the percentage exceeds 80%. THE World Health Organization (WHO) considers a rate of between 10% and 15% to be adequate and stresses that while a caesarean section can save the lives of pregnant women and children under specific conditions, it exposes women and children to unnecessary risk if performed unnecessarily.
To reduce this index in its units, the Saint Joan group, which manages the Santa Joana, Pro Matre and Santa Maria maternity hospitals, launched a project on several fronts in 2020. First, it performed a data analysis to understand the patient groups it should focus on. For this, he used the Robson classificationcreated by Irish doctor Michael Robson in 2001 and adopted by WHO and the Ministry of Health classify women according to some variable and then monitor unnecessary caesarean sections and other indicators by profile.
Through the According to Robson’s classification, pregnant women are divided into ten groups based on six variables: number of previous deliveries, number of previous cesarean deliveries, how the delivery started (spontaneous, induced or cesarean before labour), gestational age, position of the fetus and the number of fetuses in that pregnancy. In groups 1 and 3, of women with a gestational age over 37 weeks, already in labor and with the fetus in the cephalic position, for example, it is rare to have a caesarean section, but, according to data from the Ministry of Health, the rate is 43.8% and 19.1% respectively, according to 2021 data.
“These two groups, in general, are women with low-risk pregnancies, who usually want to have a vaginal birth, but the results are far from expected,” she told the Stage the Irish doctor, who advises on the Santa Joana project and was in Brazil in November. He argues that government and health professionals reward hospitals that collect and make available good quality data that allows for analysis and intervention in the care of pregnant women. “And we have to focus (the efforts) in new mothers,” says Robson.
“This analysis of indicators by groups of the Robson Classification has allowed us to organize ourselves to choose where to attack first. We have attacked groups 1 and 3 and we have already had a drop in the number of caesarean sections,” says Eduardo Cordioli, technical director of obstetrics in Santa Joana. The overall C-section rate in group maternity hospitals dropped from 89% to 79% between 2020 and 2021, with the most significant decline in women in groups 1 and 3 of the Robson classification. In group 1, the index dropped from 65% to 45%. In 3, the rate increased from 25% to 15%.
Among the measures adopted by Santa Joana is a course for pregnant women which includes information on the stages of childbirth and methods for reducing the discomforts of labour. “We have a realistic simulation center that was intended to educate professionals, but we have also started using it to educate patients. Many do not want to have a normal birth for fear of pain and, in this course, there is a lot of talk about analgesia methods “explains Monica Siaulys, medical director of Santa Joana.
When Fabiane went into labor, traumatized by her first birth, she was still thinking about having a caesarean section, but when she arrived at the maternity ward, her decision changed. “I was welcomed not only by the midwife, but by the whole team. When I arrived I was already five fingers dilated and pain free, so they asked me if I wanted to try. They offered me the ball, the massage, the essential oil I hydrated. It was a very comfortable room and I had everything to ease my pain. I felt respected,” she says.
After two hours of labor, Fabiane gave birth normally to Vicente, who is now 1 year and 4 months old, and she says she has given new meaning to the moment of having a child. “The doctor told me that I would be the protagonist of my birth. It is a moment in which we are very strong, but, at the same time, very fragile. If we don’t have people to support and encourage us, childbirth doesn’t flow, ”she says.
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Source: Terra
Ben Stock is a lifestyle journalist and author at Gossipify. He writes about topics such as health, wellness, travel, food and home decor. He provides practical advice and inspiration to improve well-being, keeps readers up to date with latest lifestyle news and trends, known for his engaging writing style, in-depth analysis and unique perspectives.
