Table 2 Predicted probabilities of all variables in the birth network
Indicator | Description | Total | Exposed to PPA | Standard of Care Group | Significance level1 |
|---|---|---|---|---|---|
Governance | |||||
Training | |||||
All | Whether the hospital staff participated in training offered by the Open School Institute for Healthcare Improvement, Sofia Feldman Hospital, and Albert Einstein Hospital | 2 | - | - | - |
Partial | 10 | ||||
Financial Bonus | |||||
No | Whether the hospital uses a financial bonus strategy to implement protocols and routines | 8 | - | - | - |
Yes | 4 | ||||
Budget | |||||
No | Whether the hospital has a budget to improve maternal and childcare | 4 | - | - | - |
Yes | 8 | ||||
Participation of Women | |||||
Good Practices Info | |||||
None | Whether women received information during pregnancy about: 1)signs of labor, 2)signs of risk danger, and 3) best practices during labor | 1113 | 25,3 (24,6 – 26,2) | 25,7 (24,8 – 26,7) | * |
At least one | 3209 | 74,7 (73,6 – 75,6) | 74,3 (73,3 – 75,2) | ||
Final Pref | |||||
Vaginal | Women’s final preference of the type of birth | 2075 | 54,1 (52,9 – 55,4) | 43,7 (42,7 – 44,9) | ** |
Cesarean/No preference | 2247 | 45,9 (44,5 – 46,8) | 56,3 (55,2 – 57,4) | ||
Ant Group | |||||
No | Whether women were offered to participate in an antenatal group activity | 2854 | 64,2 (63,3 – 65,4) | 67,6 (66,7 – 68,5) | ** |
Yes | 1468 | 35,8 (34,8 – 36,9) | 32,4 (31,3 – 33,2) | ||
Visit Hospital | |||||
No | Whether women were offered to visit the hospital where they gave birth | 2126 | 47,3 (46,3 – 48,4) | 51,0 (50,0 – 52,1) | ** |
Yes | 2196 | 52,7 (51,7 – 53,6) | 49,0 (48,5 – 50,0) | ||
Info PPA | |||||
No | Whether women knew that the hospital was a PPA participant | 2753 | 62,8 (61,7 – 63,6) | 64,7 (63,7 – 65,5) | ** |
Yes | 1569 | 37,2 (36,5 – 38,2) | 35,3 (34,2 – 36,2) | ||
Women PPA | |||||
No | Variable composed of three items: 1)if the | 2631 | 59,8 (58,9 – 60,8) | 62,6 (61,4 – 63,6) | ** |
Yes | participation of the hospital in the PPA was important for the woman’s choice of this hospital for birth; 2) if the woman visited the hospital before birth; 3) if the woman participated in a hospital antenatal group | 1691 | 40,2 (38,9 – 41,4) | 37,4 (36,5 – 38,5) | |
Source Info | |||||
Hospital/ Insurance | Whether information about best practices was provided by the hospital/insurance company, or from other sources | 277 | 8,5 (7,8 – 8,9) | 7,9 (7,3 – 8,4) | * |
Others | 4045 | 91,5 (91,0 – 91,1) | 92,1 (91,4 – 92,5) | ||
Freq Act PPA | |||||
Regular | Frequency of publication of PPA activities to women/clients | 9 | - | - | - |
Irregular | 3 | ||||
Birth Plan | |||||
No | Whether the woman prepared a birth plan | 3909 | 73,8 (72,4 – 74,9) | 82,8 (82,0 – 83,7) | ** |
Yes | 413 | 26,2 (25,0 – 27,2) | 17,2 (16,4 – 17,9) | ||
Reorganization of Care | |||||
Team Model | |||||
Hospital staff | Type of healthcare team who provided labor and childbirth care | 1532 | 62,5 (61,3 – 63,5) | 9,9 (9,2 – 10,3) | |
External/Hospital staff | 355 | 7,9 (7,1 – 8,3) | 8,5 (8,0 – 9,3) | ** | |
External | 2435 | 29,6 (28,5 – 30,5) | 81,6 (80,8 – 82,4) | ||
Team Labor | |||||
Doctor | Type of healthcare who provided labor and childbirth care | 750 | 26,5 (25,5 – 27,4) | 9,0 (8,4 – 9,6) | ** |
Doctor/ Nurse | 710 | 20,5 (19,5 – 21,3) | 13,6 (12,9 – 14,2) | ||
No labor | 2862 | 53,0 (52,0 – 54,1) | 77,4 (76,3 – 78,2) | ||
Schedule Protocol | |||||
No | Existence of a protocol for scheduling cesarean sections according to gestational age at birth | 1 | |||
> 39 weeks | 9 | - | - | - | |
> 40 or 41 weeks | 2 | ||||
Scheduled Birth | |||||
No | Whether the woman had a scheduled birth | 2445 | 76,5 (75,6 – 77,4) | 37,7 (36,7 – 38,5) | ** |
Yes | 1877 | 23,5 (22,6 – 24,5) | 62,3 (61,3 – 63,4) | ||
Cervical Dilatation | |||||
< 4 | Cervical dilation upon hospital admission | 288 | 10,5 (8,5 – 11,8) | 7,5 (6,27 – 9,1) | |
> = 4 | 1172 | 36,4 (35,5 – 38,2) | 15,1 (14,1 – 15,9) | ** | |
No labor | 2852 | 53,1 (52,0 – 54,1) | 77,4 (76,3 – 78,2) | ||
Resp Birth Plan | |||||
Respected | Whether the woman’s birth plan was respected | 361 | 15,7 (14,9 – 16,5) | 10,7 (10,0 – 11,2) | |
Not Respected/partially | 52 | 10,6 (9,7 – 11,2) | 6,1 (5,8– 7,0) | ** | |
No Birth Plan | 3909 | 73,7 (72,4 – 74,9) | 82,8 (82,0 – 83,7) | ||
Hospital Practices | |||||
< 4 recommended | Whether the woman had access to best practices during labor (oral fluids, freedom of movement, shower, non-pharmacological methods of pain relief) | 645 | 24,0 (22,4 – 25,3) | 11,3 (10,6 – 12,0) | |
> = 4 recommended | 815 | 23,0 (22,1 – 23,9) | 11,3 (10,1 – 12,6) | ** | |
No labor | 2862 | 53,0 (52,0 – 54,1) | 77,4 (76,3 – 78,2) | ||
Monitoring | |||||
Indicators | |||||
< = 4 | Whether the hospital monitors the following indicators: cesarean rate, cesarean rate by Robson group, childbirth care by | 2 | - | - | - |
> 4 | nurses/midwives, vaginal birth with episiotomy, admission to Neonatal Intensive Care Unit, proportion of early-term births (37–38 gestational weeks) | 10 | |||
Freq Indicators | |||||
No frequency | Frequency of feedback regarding perinatal indicators | 6 | |||
Regular | 1 | - | - | - | |
Irregular | 3 | ||||
Does not monitor indicators | 2 | ||||
Feedback | |||||
Each Doctor | Identifying which professionals gathered feedback on results of perinatal indicators | 6 | - | - | - |
Doctors + Team | 3 | ||||
Doctors + Team + User | 3 | ||||
Confounders | |||||
Economic Class | |||||
A/A2 | Brazilian economic classification | 944 | 21,9 (21,1 – 22,9) | 21,9 (21,0 – 22,8) | |
B1/B2 | 2454 | 56,7 (55,2 – 57,9) | 56,7 (55,7 – 58,0) | NS | |
C1/C2 | 924 | 21,4 (20,3 – 22,1) | 21,4 (20,2 – 22,1) | ||
Skin Colour | |||||
White | Self-reported skin colour of women | 2780 | 63,1 (62,0 – 64,0) | 63,2 (62,1 – 64,2) | NS |
Non-white | 1610 | 36,9 (35,8 – 37,7) | 36,8 (35,9 – 37,8) | ||
Robson | |||||
1–4 | Classification of women into Robson groups 1 to 4 | 2473 | 79,4 (78,2 – 80,1) | 37,7 (36,7 – 38,8) | ** |
5–10 | 1849 | 20,6 (19,8 – 21,9) | 62,3 (31,2 – 63,7) | ||