Is it possible to reduce cesarean sections in hypertensive women without increasing the occurrence of negative outcomes?

The Adequate Childbirth Project (Projeto Parto Adequado - PPA) is an initiative by the National Supplementary Health Agency aimed at reducing the occurrence of cesarean sections in private hospitals in Brazil. However, it is still unknown whether the project is effective in reducing cesarean sections in hypertensive women, which is the objective of this study. This is a cross-sectional study with hypertensive women who participated in the Nascer Saudável - 2017 study. A total of 382 women were included in this analysis. The exposure variable was participation in the PPA, and the outcomes assessed were spontaneous labor onset, mode of delivery, severe maternal morbidity, and neonatal near miss. The PPA increased the likelihood of hypertensive women going into labor and having a vaginal delivery. Furthermore, the results show that participating in the PPA did not increase the likelihood of severe maternal morbidity or neonatal near miss, assessed using the World Health Organization criteria and the Nascer no Brasil study criteria. This study highlighted positive results for the Adequate Childbirth Project in promoting the physiology of childbirth, concluding that it is possible to reduce cesarean sections in hypertensive women without increasing the occurrence of negative maternal and neonatal outcomes.