Table 1 Birth network variables
Variable name | Variable description | Answer categories | Source of data |
|---|---|---|---|
I – Governance | |||
Training | Whether the hospital staff participated in training offered by the Open School Institute for Healthcare Improvement, Sofia Feldman Hospital, and Albert Einstein Hospital | “All”—for three instances of training; “Two or less”—for 0 to 2 instances of training | Management interview |
Financial Bonus | Whether the hospital uses a financial bonus strategy to implement protocols and routines | Yes, No | Management interview |
Budget | Whether the hospital has a budget to improve maternal and childcare | Yes, No | Management interview |
II) Participation of women | |||
Good Practice Info | Whether women received information during pregnancy about: 1)signs of labor, 2)signs of risk danger, and 3) best practices during labor | None – received no information; Yes – received at least one information | Interview with women |
Final Pref | Women’s final preference of the type of birth | Vaginal; Cesarean/no preference | Interview with women |
Ant Group | Whether women were offered to participate in an antenatal group activity | Yes, No | Interview with women |
Visit Hospital | Whether women were offered to visit the hospital where they gave birth | Yes, No | Interview with women |
Info PPA | Whether women knew that the hospital was a PPA participant | Yes, No | Interview with women |
Women PPA | Variable composed of three items: 1)if the 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 | All – to women who responded “yes” to the three questions; and two or less – to women who responded “yes” to two or fewer questions | Interview with women |
Source Info | Whether information about best practices was provided by the hospital/insurance company, or from other sources | Hospital/Health Insurance Company; Other sources | Interview with women |
Freq Act PPA | Frequency of publication of PPA activities to women/clients | Regular or Non-regular | Management interview |
Birth Plan | Whether the woman prepared a birth plan | Yes, No | Interview with women |
III) Reorganization of care: | |||
Team Model | Type of healthcare team who provided labor and childbirth care | Hospital Staff, External and Hospital Staff, only External Staff | Interview with women |
Team Labor | Type of healthcare who provided labor and childbirth care | Doctor, Nurse and Doctor, No Labor | Interview with women |
Schedule Protocol | Existence of a protocol for scheduling cesarean sections according to gestational age at birth | Yes, No | Management interview |
Scheduled Birth | Whether the woman had a scheduled birth | Yes, No | Interview with women |
Cervical Dilatation | Cervical dilation upon hospital admission | No Labor, < 4 cm, > = 4 cm | Medical records |
Resp Birth Plan | Whether the woman’s birth plan was respected | Respected, Not Respected, No Birth Plan | Interview with women |
Hospital Practices | Whether the woman had access to best practices during labor (oral fluids, freedom of movement, shower, non-pharmacological methods of pain relief) | < 4 items, > = 4 items, No Labor | Interview with women |
IV) Monitoring | |||
Indicators | Whether the hospital monitors the following indicators: cesarean rate, cesarean rate by Robson group, childbirth care by nurses/midwives, vaginal birth with episiotomy, admission to Neonatal Intensive Care Unit, proportion of early-term births (37–38 gestational weeks) | < = 4 items, 5 or 6 items | Management interview |
Feedback | Identifying which professionals gathered feedback on results of perinatal indicators | Each doctor individually; Doctors and Team; Doctors, Team and User | Management interview |
Freq Indicators | Frequency of feedback regarding perinatal indicators | No frequency, Regular, irregular, hospital does not monitor indicators | Management interview |
V) Confounders | |||
Economic Class32 | Brazilian economic classification | A1/A2, B1/B2, and C1/C2 (where “A” represents the highest economic class) | Interview with women |
Skin Colour | Self-reported skin colour of women | White, Non-White | Interview with women |
Robson14 | Classification of women into Robson groups 1 to 4 | Yes, No | Medical records |
VI) Exposed | |||
Exposed To PPA | Whether woman was targeted by the PPA model of care | Yes, No | Management Interview |
VII) Context | |||
Hospital | Whether the hospital belonged to a health insurance company | Yes, No | Management interview |
VIII) Outcome | |||
Birth Type | Type of birth | Vaginal/forceps, Cesarean section | Interview with women |