Use of intrapartum evidence-based practices in childbirth after participating in the Senses of Birth intervention among Brazilian women

Brazil has a cesarean rate of 56% and low use of Intrapartum
Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered
and highly interventionist maternal health care model. The Senses of Birth
(SoB) is a health education intervention created to promote normal birth,
use of EBP, and reduce unnecessary c-sections. This study aimed to
understand the use of intrapartum EBP by Brazilian women who participated
in the SoB intervention. 555 women answered the questionnaire between 2015
and 2016. Bivariate analysis and ANOVA test were used to identify if
social-demographic factors, childbirth information, and perceived
knowledge were associated with the use of EBP. A qualitative analysis was
performed to explore women's experiences. Research participants used
the following EBP: birth plan (55.2%), companionship during childbirth
(81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%),
choice of position during delivery (57.2%), and non-pharmacological pain
relief methods (74.2%). Doula support was low (26.9%). Being a black woman
was associated with not using a birth plan or having doula support. Women
who gave birth in private hospitals were more likely not to use the EBP.
Barriers to the use of EBP identified by women were an absence of
individualized care, non-respect for their choices or provision of EBP by
health care providers, inadequate structure and ambiance in hospitals to
use EBP, and rigid protocols not centered on women’s needs. The SoB
intervention was identified as a potential facilitator. Women who used EBP
described a sense of control over their bodies and self-efficacy to
advocate for their chosen practices. Women saw the strategies to overcome
barriers as a path to become their childbirth protagonist. Health
education is essential to increase the use of EBP; however, it should be
implemented combined with changes in the maternal care system, promoting
woman-centered and evidence-based models.

巴西的剖宫产率为56%，而产时循证实践（Intrapartum Evidence-based Practices, IEBP）的使用率仅为3.4%，这反映出其以医疗为中心、高度干预性的孕产妇保健模式。

‘生育感知’（Senses of Birth, SoB）是一项健康教育干预措施，旨在促进自然分娩、提高循证实践（Evidence-based Practices, EBP）使用率并减少不必要的剖宫产。本研究旨在了解参与SoB干预的巴西女性对产时循证实践的使用情况。

2015年至2016年间，共有555名女性完成了问卷调查。研究采用双变量分析和方差分析（ANOVA）检验，以确定社会人口学因素、分娩知识及感知认知是否与循证实践的使用相关；同时通过定性分析探讨女性的分娩体验。

研究参与者使用的循证实践包括：分娩计划（55.2%）、分娩陪伴（81.6%）、助产士护理（54.2%）、产程中自由活动（57.7%）、分娩体位选择（57.2%）及非药物镇痛方法（74.2%）。而导乐支持的使用率较低（26.9%）。

黑人女性与不使用分娩计划或未获得导乐支持存在关联；在私立医院分娩的女性更倾向于不使用循证实践。

女性指出的循证实践使用障碍包括：缺乏个性化护理、医护人员不尊重其选择或未提供循证实践服务、医院缺乏支持循证实践的设施与环境，以及未以女性需求为中心的僵化诊疗方案。而SoB干预被认为是潜在的促进因素。

使用循证实践的女性表示，她们对自己的身体有掌控感，并具备为所选实践发声的自我效能感；女性将克服障碍的策略视为成为分娩主角的途径。

健康教育对于提高循证实践使用率至关重要，但需结合孕产妇保健体系的变革，推动以女性为中心的循证模式发展。