Childbirth and newborn care: Progress and challenges of the Nascer Bem Movement in Caruaru

Abstract

This study evaluated the implementation of maternal and newborn care during labor and birth in a maternity hospital located in the rural region of Pernambuco, Brazil, with a focus on the contributions of the Nascer Bem Caruaru Movement. Employing an evaluative research design grounded in implementation analysis, the study adopted a case study approach with data triangulation and a mixed-methods strategy. Research techniques included interviews, direct observation, and document analysis. The analysis was structured around three contextual categories: government project, state capacity, and governability. The degree of implementation was assessed across five dimensions: activation of the care network and collaborative care practices, adherence to evidence-based practices, monitoring of care and outcomes, participatory and shared management, and the enabling environment. The maternity hospital demonstrated strong performance in several areas, including patient reception protocols, nurse-led obstetric care, the referral process for pregnant women, and the promotion of a care environment conducive to good practices. Municipal governance also showed potential to drive change, as evidenced by the enactment of Law No. 5,951/2017 on the humanization of care during pregnancy, childbirth, and abortion, and by reductions in infant mortality rates following the implementation of the Nascer Bem Caruaru initiative. However, key challenges remain, particularly in overcoming the entrenched interventionist model of childbirth care and addressing weaknesses in regional health governance.