Structure and practices of Brazilian teaching hospitals: an assessment before and after the Apice ON Project

This study identifies structural changes, changes in the delivery of care, and trends in the use of cesarean sections in teaching hospitals participating in the Apice ON project, which focuses on transforming the teaching and delivery of obstetric and neonatal care towards a humanized, evidence-based approach. A descriptive and exploratory study was conducted using secondary data from the National Registry of Health Establishments, the Hospital Information System, and the Live Birth Information System from before the project (first half of 2017) and near its completion (second half of 2019). The study found progress in the provision of specialized facilities such as-high-risk maternity homes and in-hospital birth centers; an increase in the number of obstetric nurses; a three-percentage-point increase in births assisted by these professionals; an increase in births in low-risk cesarean groups (Robson groups 1 to 4); and a decrease in unclassified births. Overall, however, cesarean section rates remained high, even in the groups where they should be reduced (Robson groups 1, 3, and 5).