Collaborative model of intrapartum care: qualitative study on barriers and facilitators to implementation in a private Brazilian hospital
Introduction A collaborative (midwife-obstetrician) model of intrapartum care (CMIC) is associated with lower caesarean section (CS) rates than physician-led models. In 2019, the largest private maternity hospital in Latin America (14.000 deliveries/year, 89% CS) created a quality improvement initia...
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BMJ Publishing Group
2021-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/12/e053636.full |
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| author | Mercedes Colomar Ana Pilar Betran Maria Regina Torloni Meghan A Bohren Newton Opiyo Monica Siaulys Franco Gonzalez Mora |
| author_facet | Mercedes Colomar Ana Pilar Betran Maria Regina Torloni Meghan A Bohren Newton Opiyo Monica Siaulys Franco Gonzalez Mora |
| author_sort | Mercedes Colomar |
| collection | DOAJ |
| description | Introduction A collaborative (midwife-obstetrician) model of intrapartum care (CMIC) is associated with lower caesarean section (CS) rates than physician-led models. In 2019, the largest private maternity hospital in Latin America (14.000 deliveries/year, 89% CS) created a quality improvement initiative to optimise intrapartum care and safely reduce CS in low-risk women managed by its internal team of healthcare providers (HCP). We conducted formative research to identify potential barriers and facilitators to the implementation of a CMIC.Methods Three groups of stakeholders participated in focus groups and interviews: hospital managers and clinical coordinators, HCP working in labour/delivery wards and pregnant women intending to give birth in the hospital. We explored participants’ views about the acceptability of implementing a CMIC where a nurse-midwife (NM) on shift would be the main intrapartum HCP, with continuous support/supervision of a dedicated, in-house, obstetrician-gynaecologist (OB-GYN). A thematic analysis approach was used.Results 12 HCPs, 5 clinical coordinators, 2 hospital managers and 7 women participated. OB-GYNs, coordinators and managers highlighted health system, organisational and structural factors (NMs’ limited experience/skills, professional roles, financial reimbursement) as potential barriers. NMs identified logistical and human resources as additional barriers. Women viewed the CMIC with perplexity and insecurity because of cultural beliefs about the dominant role of OB-GYNs, and limited information about NM’s capabilities. All professionals agreed that women’s acceptance of a CMIC will require educational interventions and communication strategies to inform potential users about the advantages and safety of this model.Conclusion There are important barriers and facilitators to implement a CMIC in a private Brazilian maternity hospital. Factors related to health system structure and organisation may have the greatest impact. A CMIC is more likely to succeed if stakeholders’ concerns about responsibilities, power and financial revenues are addressed, and educational interventions targeted at users are deployed prior to its implementation. |
| format | Article |
| id | doaj-art-7c72394c5c7944d2bacf55b70e04b1cb |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-7c72394c5c7944d2bacf55b70e04b1cb2024-12-10T14:15:09ZengBMJ Publishing GroupBMJ Open2044-60552021-12-01111210.1136/bmjopen-2021-053636Collaborative model of intrapartum care: qualitative study on barriers and facilitators to implementation in a private Brazilian hospitalMercedes Colomar0Ana Pilar Betran1Maria Regina Torloni2Meghan A Bohren3Newton Opiyo4Monica Siaulys5Franco Gonzalez Mora6Montevideo Clinical and Epidemiological Research Unit, Montevideo, UruguayReproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, SwitzerlandHospital e Maternidade Santa Joana, Sao Paulo, BrazilCentre for Health Equity, University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia2 UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandHospital e Maternidade Santa Joana, Sao Paulo, BrazilHealth Sociology Unit, University of the Republic of Uruguay Faculty of Medicine, Montevideo, UruguayIntroduction A collaborative (midwife-obstetrician) model of intrapartum care (CMIC) is associated with lower caesarean section (CS) rates than physician-led models. In 2019, the largest private maternity hospital in Latin America (14.000 deliveries/year, 89% CS) created a quality improvement initiative to optimise intrapartum care and safely reduce CS in low-risk women managed by its internal team of healthcare providers (HCP). We conducted formative research to identify potential barriers and facilitators to the implementation of a CMIC.Methods Three groups of stakeholders participated in focus groups and interviews: hospital managers and clinical coordinators, HCP working in labour/delivery wards and pregnant women intending to give birth in the hospital. We explored participants’ views about the acceptability of implementing a CMIC where a nurse-midwife (NM) on shift would be the main intrapartum HCP, with continuous support/supervision of a dedicated, in-house, obstetrician-gynaecologist (OB-GYN). A thematic analysis approach was used.Results 12 HCPs, 5 clinical coordinators, 2 hospital managers and 7 women participated. OB-GYNs, coordinators and managers highlighted health system, organisational and structural factors (NMs’ limited experience/skills, professional roles, financial reimbursement) as potential barriers. NMs identified logistical and human resources as additional barriers. Women viewed the CMIC with perplexity and insecurity because of cultural beliefs about the dominant role of OB-GYNs, and limited information about NM’s capabilities. All professionals agreed that women’s acceptance of a CMIC will require educational interventions and communication strategies to inform potential users about the advantages and safety of this model.Conclusion There are important barriers and facilitators to implement a CMIC in a private Brazilian maternity hospital. Factors related to health system structure and organisation may have the greatest impact. A CMIC is more likely to succeed if stakeholders’ concerns about responsibilities, power and financial revenues are addressed, and educational interventions targeted at users are deployed prior to its implementation.https://bmjopen.bmj.com/content/11/12/e053636.full |
| spellingShingle | Mercedes Colomar Ana Pilar Betran Maria Regina Torloni Meghan A Bohren Newton Opiyo Monica Siaulys Franco Gonzalez Mora Collaborative model of intrapartum care: qualitative study on barriers and facilitators to implementation in a private Brazilian hospital BMJ Open |
| title | Collaborative model of intrapartum care: qualitative study on barriers and facilitators to implementation in a private Brazilian hospital |
| title_full | Collaborative model of intrapartum care: qualitative study on barriers and facilitators to implementation in a private Brazilian hospital |
| title_fullStr | Collaborative model of intrapartum care: qualitative study on barriers and facilitators to implementation in a private Brazilian hospital |
| title_full_unstemmed | Collaborative model of intrapartum care: qualitative study on barriers and facilitators to implementation in a private Brazilian hospital |
| title_short | Collaborative model of intrapartum care: qualitative study on barriers and facilitators to implementation in a private Brazilian hospital |
| title_sort | collaborative model of intrapartum care qualitative study on barriers and facilitators to implementation in a private brazilian hospital |
| url | https://bmjopen.bmj.com/content/11/12/e053636.full |
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