Measuring harm-free care in childbirth: a pilot application of the maternity safety thermometer in Brazil


  • Bruna Dias Alonso aRM, BSc, MSc, PhD. Department of Health, Life Cycles, and Society; School of Public Health, University of São Paulo, Brazil. Midwifery course; School of Arts, Sciences and Humanities, University of São Paulo, Brazil.
  • Denise Yoshie Niy bMSc, PhD. Department of Health, Life Cycles, and Society; School of Public Health, University of São Paulo, Brazil.
  • Cláudia de Azevedo Aguiar cBSc, MSc, PhD. Department of Public Health, Federal University of Triângulo Mineiro, Brazil.
  • Eder Lucio da Fonseca dMSc, PhD. John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, USA.
  • Jane Sandall eBSc, MSc, PhD. Department of Women and Children’s Health, Faculty of Life Sciences and Medicine, King’s College London, UK.
  • Carmen Simone Grilo Diniz fMD, MSc, PhD. Department of Health, Life Cycles, and Society; Public Health School of University of São Paulo, Brasil.



Hospitals, Maternity, Patient Safety, Outcome Assessment, Health Care


Introduction: In Brazil, interventions during labor and childbirth are harmful and, for the most part, unnecessary. In addition, there is a high prevalence of abuse and disrespect for women and babies during this period.

Objective: To describe the prevalence of maternal and neonatal harm and harm-free care in a Brazilian maternity setting.

Methods: Pilot application of the Portuguese version of Maternal Safety Thermometer (MST) by a cross-sectional study in a public setting. Data collection was made at two timepoints.

Results: 140 women were included. Over 84% of women had a postpartum sutured wound, resulting from a caesarean section, an episiotomy, or a perineal trauma. Puerperal infection, especially on a caesarean wound, was the most frequent physical harm. Women’s perception of safety, including being left alone in labour, and feeling their safety concerns were not taken seriously, decreased from 80.6% to 43.3% in the second timepoint. Using the MST helped to improve the quality of medical records since critical information about a patient’s health status was not properly recorded, or even absent.

Conclusion: MST is a concise tool and includes indicators related to harm-free care in a short time range. However, this study suggests that the MST can underestimate harm if it is used alone to assess harm-free care in maternities with excessive levels of intervention, and poor reporting of harms (i.e., blood loss), as in most Brazilian settings.


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