Measuring harm-free care in childbirth: a pilot application of the Maternity Safety Thermometer in Brazil

Abstract

Introduction: interventions during labour and childbirth are frequently unnecessary and can be harmful to most women and babies in Brazil. In addition, there is a high prevalence of abuse and disrespect situations. Objective: to describe the prevalence of maternal and neonatal harm and harm-free care in a Brazilian maternity setting. Methods: pilot application of the Portuguese version of Maternal Safety Thermometer (MST) by a cross-sectional study in a public setting. Data collection was made at two timepoints. Results: 140 women were included. Over 84% of women had a postpartum sutured wound, resulting from a caesarean section, an episiotomy, or a perineal trauma. Puerperal infection, especially on a caesarean wound, was the most frequent physical harm. Women’s perception of safety, including being left alone in labour, and feeling their safety concerns were not taken seriously, decreased from 80.6% to 43.3% in the second timepoint. Using the MST helped to improve the quality of medical records since critical information about a patient’s health status was not properly recorded, or even absent. Conclusion: MST is a concise tool which includes indicators related to harm-free care measured in a short time range. However, this study suggests that the MST can underestimate harm if it is used alone to assess harm-free care in maternities with excessive levels of intervention, and poor reporting of harms (i.e., blood loss), as in most Brazilian settings.