Brazilian women's use of evidence-based practices in childbirth after participating in the Senses of Birth intervention: A mixed-methods study

PLoS One. 2021 Apr 16;16(4):e0248740. doi: 10.1371/journal.pone.0248740. eCollection 2021.

Abstract

Brazil has a cesarean rate of 56% and low use of Intrapartum Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered and highly interventionist maternal health care model. The Senses of Birth (SoB) is a health education intervention created to promote normal birth, use of EBP, and reduce unnecessary c-sections. This study aimed to understand the use of intrapartum EBP by Brazilian women who participated in the SoB intervention. 555 women answered the questionnaire between 2015 and 2016. Bivariate analysis and ANOVA test were used to identify if social-demographic factors, childbirth information, and perceived knowledge were associated with the use of EBP. A qualitative analysis was performed to explore women's experiences. Research participants used the following EBP: birth plan (55.2%), companionship during childbirth (81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%), choice of position during delivery (57.2%), and non-pharmacological pain relief methods (74.2%). Doula support was low (26.9%). Being a black woman was associated with not using a birth plan or having doula support. Women who gave birth in private hospitals were more likely not to use the EBP. Barriers to the use of EBP identified by women were an absence of individualized care, non-respect for their choices or provision of EBP by health care providers, inadequate structure and ambiance in hospitals to use EBP, and rigid protocols not centered on women's needs. The SoB intervention was identified as a potential facilitator. Women who used EBP described a sense of control over their bodies and perceived self-efficacy to advocate for their chosen practices. Women saw the strategies to overcome barriers as a path to become their childbirth protagonist. Health education is essential to increase the use of EBP; however, it should be implemented combined with changes in the maternal care system, promoting woman-centered and evidence-based models.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brazil / ethnology
  • Delivery, Obstetric / trends
  • Early Medical Intervention / methods
  • Early Medical Intervention / trends
  • Evidence-Based Practice / trends*
  • Female
  • Health Education / trends
  • Humans
  • Labor, Obstetric / psychology
  • Maternal Health Services / trends
  • Middle Aged
  • Midwifery / trends
  • Parturition / psychology*
  • Pregnancy
  • Pregnant Women / psychology
  • Prenatal Care / methods*
  • Prenatal Care / trends
  • Professional-Patient Relations
  • Surveys and Questionnaires

Associated data

  • Dryad/10.5061/dryad.r7sqv9sb8

Grants and funding

This work was supported by funding from a group of organizations list bellow, part of the call MCTI/CNPq/MS/SCTIE/Decit/Fundação Bill e Melinda Gates N o 05/2013 Organizations: - National Council of Technological and Scientific Development (CNPq)- http://www.cnpq.br/web/guest/fomento-tecnologico, - Ministry of Health - https://www.saude.gov.br/trabalho-educacao-e-qualificacao/gestao-e-regulacao-do-trabalho-em-saude/premio-inovasus, - Bill and Melinda Gates Foundation -https://www.gatesfoundation.org/, - Pan-American Health Organization - https://www.paho.org/bra/, - Funding Agency of the State of Minas Gerais (FAPEMIG) - https://fapemig.br/pt/. The funding was directed to implement the health education intervention and data collection. Authors did not receive personal funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.