A change laboratory for maternity care in Brazil: Pilot implementation of Mother Baby Friendly Birthing Initiative

Abstract

Disrespectful and abusive treatment of women during childbirth is a worldwide problem. This research aimed to develop and implement a Mother Baby-Friendly Hospital Initiative (MBFHI) in an academic maternity hospital in Brazil and evaluate how change could be sustained. Change Laboratory principles guided a process of action research, which was conducted between 2017 and 2019. Clinicians and managers joined the researchers in discussion sessions to redesign routines and care pathways. Observation, interviews, focus groups, and historical and documentary analysis provided information about the existing activity system, which we analysed qualitatively using MBFHI criteria to identify themes. Evidence of inappropriate obstetric interventions and impersonal interactions between clinicians and patients stimulated us to devise innovative solutions. The challenges identified by this exercise included: poor infrastructure and ambience; difficulty adhering to evidence-based protocols; social and professional hierarchies; and clinicians being poorly educated about women's rights. Although challenges remained, positive changes included a friendlier environment, improved patient privacy, and fewer unnecessary procedures. Resources released by these changes allowed us, collaboratively, to track the further implementation and sustainability of change. We conclude that the Change Laboratory can help motivated clinicians and managers humanise patients’ experiences, make care more evidence-based, and expand learning of mother-friendly maternity care. Tensions and contradictions between education and patient care reported here may resonate in settings other than maternity care.

Keywords:

• Change laboratory
• medical teaching
• maternity services
• respectful care
• cultural historical activity theory (CHAT)

Acknowledgements

We want to express our gratitude to Heloísa Salgado, Denise Niy and Bruna Alonso for their invaluable contribution to the field work and commentaries, and to Amanda Macaia da Silva and Rodolfo Vilella, for introducing us to Change Laboratory and for assisting us in our learning process.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 The MBFBFI was reformatted in 2018 and now is called International Childbirth Initiative (ICI) and has 12 steps. https://www.figo.org/news/launching-international-childbirth-initiative-ici-0016152.

Additional information

Funding

This work was supported by the Sao Paulo Research Foundation (Fundação de Amparo à Pesquisa do Estado de São Paulo, FAPESP), process 15/50498-0.

Notes on contributors

Carmen Simone Grilo Diniz

Carmen Simone Grilo Diniz, MD, PhD, professor, School of Public Health, University of São Paulo, Sao Paulo, Brazil.

Jamile Claro de Castro Bussadori

Jamile Claro de Castro Bussadori, RNM, PhD, professor, Department of Nursing, Universidade Federal de São Carlos (Federal University of Sao Carlos), São Carlos, Brazil.

Luana Beatriz Lemes

Luana Beatriz Lemes, PT, MSc, School of Public Health, University of Sao Paulo, São Paulo, Brazil.

Elaine Christine Dantas Moisés

Elaine Christine Dantas Moisés, MD, PhD, professor, Department of Gynecology & Obstetrics, Ribeirão Preto School of Medicine (FMRP), University of São Paulo, Ribeirão Preto, Brazil.

Caio Antonio de Campos Prado

Caio Antonio de Campos Prado, MD, MSc, Women’s Health Reference Centre of Ribeirão Preto (MATER), Ribeirão Preto, São Paulo, Brazil.

Christine McCourt

Christine McCourt, BA, PhD, professor, School of Health Sciences, City, University of London, London, United Kingdom.