City Research Online

A change laboratory for maternity care in Brazil: Pilot implementation of Mother Baby Friendly Birthing Initiative

Grilo Diniz, C. S., de Castro Bussadori, J. C., Lemes, L. B. , Dantas Moises, E. C., de Campos Prado, C. A. & McCourt, C. ORCID: 0000-0003-4765-5795 (2021). A change laboratory for maternity care in Brazil: Pilot implementation of Mother Baby Friendly Birthing Initiative. Medical Teacher, 43(1), pp. 19-26. doi: 10.1080/0142159x.2020.1791319


Disrespectful and abusive treatment of women during childbirth is a worldwide problem. This research aimed to develop and implement a Mother Baby-Friendly Hospital Initiative (MBFHI) in an academic maternity hospital in Brazil and evaluate how change could be sustained. Change Laboratory principles guided a process of action research, which was conducted between 2017 and 2019. Clinicians and managers joined the researchers in discussion sessions to redesign routines and care pathways. Observation, interviews, focus groups, and historical and documentary analysis provided information about the existing activity system, which we analysed qualitatively using MBFHI criteria to identify themes. Evidence of inappropriate obstetric interventions and impersonal interactions between clinicians and patients stimulated us to devise innovative solutions. The challenges identified by this exercise included: poor infrastructure and ambience; difficulty adhering to evidence-based protocols; social and professional hierarchies; and clinicians being poorly educated about women's rights. Although challenges remained, positive changes included a friendlier environment, improved patient privacy, and fewer unnecessary procedures. Resources released by these changes allowed us, collaboratively, to track the further implementation and sustainability of change. We conclude that the Change Laboratory can help motivated clinicians and managers humanise patients’ experiences, make care more evidence-based, and expand learning of mother-friendly maternity care. Tensions and contradictions between education and patient care reported here may resonate in settings other than maternity care.

Publication Type: Article
Additional Information: This is an Accepted Manuscript of an article published by Taylor & Francis in Medical Teacher on 16th July 2021, available online:
Publisher Keywords: Change laboratory, medical teaching, maternity services, respectful care, cultural historical activity theory (CHAT)
Subjects: H Social Sciences > HQ The family. Marriage. Woman
R Medicine > RG Gynecology and obstetrics
Departments: School of Health & Psychological Sciences > Midwifery & Radiography
SWORD Depositor:
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