Attention to childbirth and delivery in a university hospital: comparison of practices developed after Network Stork.
Giovanna De Carli Lopes, Annelise de Carvalho Gonçalves, Helga Geremias Gouveia and 1 others
PMID 31038633WHAT IT FOUND
Skin-to-skin contact, breastfeeding encouragement, companions and non-drug pain relief improved at a university maternity hospital four years after joining Brazil's Stork Network, but IV fluids, Kristeller, analgesics and excessive exams increased and freedom of movement fell.
Key findings
01In this hospital, companion presence at delivery or cesarean section rose from 91.0% to 95.7%, non-pharmacological pain relief rose from 67.9% to 74.2%, skin-to-skin contact rose from 14.9% to 60.1%, and early breastfeeding encouragement rose from 22.1% to 45.0%, while freedom of position and movement fell from 53.9% to 44.9%.
02Venoclysis during labor rose from 85.4% to 97.8%, Kristeller's maneuver rose from 8.5% to 13.6%, analgesics rose from 44.4% to 75.1%, analgesia rose from 20.3% to 45.9%, and digital exams above recommended rose from 69.5% to 76.8% (p = 0.055).
03Episiotomy fell from 63.6% to 55.0%, trichotomy fell from 81.3% to 64.0%, and in-hospital trichotomy fell from 25.3% to 8.8%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational before-after comparison in one university hospital, not a randomised trial, so it cannot show that the Stork Network caused the changes. The two samples differed significantly in self-reported race/color and schooling, which may affect comparability. The 2012 and 2016 data instruments differed, and the 2016 instrument was reviewed and improved. Some records were incomplete or absent, so the partograph and the duration of skin-to-skin contact could not be evaluated. The hospital is a high-risk referral unit with a traditional physician-led model, so the practices may not apply to other settings.
Declared interests
No funding or conflict-of-interest declaration is provided in the supplied text.
The easy way to misread this
Do not read the increases in skin-to-skin contact and breastfeeding encouragement as proof that the Stork Network caused better care. This was an observational before-after comparison in one hospital, and several harmful or inappropriate practices increased or remained common.