{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T07:20:25Z","timestamp":1789802425048,"version":"4.0.1"},"reference-count":26,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["409972\/2021\u20105"],"award-info":[{"award-number":["409972\/2021\u20105"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,9]]},"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n This study examines whether hospitals with stronger patient safety culture more consistently follow essential birth practices and have fewer adverse outcomes for mothers and newborns and whether this evidence can guide maternity care priorities in patient safety policy.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted a multicenter cross\u2010sectional study in six public maternity hospitals in Brazil (November 2022 to February 2024). In each hospital, we measured patient safety culture using the Brazilian version of the Hospital Survey on Patient Safety Culture. From a systematic sample of 2183 births (approximately 360 per hospital), we reviewed charts to record eight essential obstetric and neonatal practices and 10 adverse outcomes. We created hospital\u2010level composites for the practice bundle and adverse outcomes and correlated them with culture scores using Spearman coefficients (one\u2010sided exact\n P<\/jats:italic>\n \u2010values).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 686 professionals responded to the survey, with a mean overall culture score of 43.6% (range: 29.5%\u201356.4%). \u201cPerception of safety\u201d and \u201cnon\u2010punitive response to errors\u201d were consistently low, while \u201cmanagement expectations,\u201d \u201corganizational learning,\u201d and \u201cteamwork within units\u201d were relative strengths. Adherence was high for postpartum oxytocin (93.4%), vitamin K (95.9%), and newborn identification (91.1%), and low for partogram initiation (36.4%), birth companion (48.1%), and breastfeeding within the first hour (47.5%). Culture scores aligned positively with the practice bundle (\n \u03c1\u2009=<\/jats:italic>\n \u20090.77;\n P\u2009=<\/jats:italic>\n \u20090.072) and inversely with adverse outcomes\u2014maternal (\n \u03c1\u2009=<\/jats:italic>\n \u2009\u22120.77;\n P\u2009=<\/jats:italic>\n \u20090.072), neonatal (\n \u03c1\u2009=<\/jats:italic>\n \u2009\u22120.89;\n P\u2009=<\/jats:italic>\n \u20090.019), and total (\n \u03c1\u2009=<\/jats:italic>\n \u2009\u22120.94;\n P\u2009=<\/jats:italic>\n \u20090.005).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Findings support pairing culture\u2010strengthening actions with clinical bundles to promote safer childbirth and prioritize maternity services in safety policy.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ijgo.70890","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T11:33:42Z","timestamp":1773315222000},"page":"1316-1327","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between patient safety culture, adverse events, and essential practices during childbirth in six Brazilian maternity hospitals"],"prefix":"10.1002","volume":"174","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0818-9680","authenticated-orcid":false,"given":"Zenewton A. S.","family":"Gama","sequence":"first","affiliation":[{"name":"Department of Collective Health Federal University of Rio Grande do Norte\u2013UFRN Natal Rio Grande do Norte Brazil"},{"name":"Graduate Program in Quality Management in Health Services (QualiSa\u00fade) Federal University of Rio Grande do Norte\u2013UFRN Natal Rio Grande do Norte Brazil"},{"name":"Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4225-5194","authenticated-orcid":false,"given":"Cec\u00edlia Ol\u00edvia Paraguai de Oliveira","family":"Saraiva","sequence":"additional","affiliation":[{"name":"Department of Collective Health Federal University of Rio Grande do Norte\u2013UFRN Natal Rio Grande do Norte Brazil"},{"name":"Graduate Program in Quality Management in Health Services (QualiSa\u00fade) Federal University of Rio Grande do Norte\u2013UFRN Natal Rio Grande do Norte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0233-3119","authenticated-orcid":false,"given":"Tatyana Maria Silva de Souza","family":"Rosendo","sequence":"additional","affiliation":[{"name":"Department of Collective Health Federal University of Rio Grande do Norte\u2013UFRN Natal Rio Grande do Norte Brazil"},{"name":"Graduate Program in Quality Management in Health Services (QualiSa\u00fade) Federal University of Rio Grande do Norte\u2013UFRN Natal Rio Grande do Norte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7977-7960","authenticated-orcid":false,"given":"Rose L.","family":"Molina","sequence":"additional","affiliation":[{"name":"Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health Boston Massachusetts USA"},{"name":"Department of Obstetrics and Gynecology Beth Israel Deaconess Medical Center Boston Massachusetts USA"},{"name":"Department of Medicine Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8360-1391","authenticated-orcid":false,"given":"Katherine E. A.","family":"Semrau","sequence":"additional","affiliation":[{"name":"Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health Boston Massachusetts USA"},{"name":"Department of Medicine Harvard Medical School Boston Massachusetts USA"},{"name":"Division of Global Health Equity Brigham and Women's Hospital Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7643-5268","authenticated-orcid":false,"given":"Danielle E.","family":"Tuller","sequence":"additional","affiliation":[{"name":"Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6371-8226","authenticated-orcid":false,"given":"Megan Marx","family":"Delaney","sequence":"additional","affiliation":[{"name":"Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8914-4021","authenticated-orcid":false,"given":"Christopher","family":"Westgard","sequence":"additional","affiliation":[{"name":"Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0876-8271","authenticated-orcid":false,"given":"Lauren","family":"Bobanski","sequence":"additional","affiliation":[{"name":"Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5286-3815","authenticated-orcid":false,"given":"Cl\u00e1udia Maria","family":"Messias","sequence":"additional","affiliation":[{"name":"Maternal, Child and Psychiatric Department Fluminense Federal University Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7449-4816","authenticated-orcid":false,"given":"Liana Carlan","family":"Padilha","sequence":"additional","affiliation":[{"name":"Undergraduate Course in Collective Health Federal University of Rio Grande do Norte\u2013UFRN Natal Rio Grande do Norte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5679-6672","authenticated-orcid":false,"given":"Marise Reis","family":"de Freitas","sequence":"additional","affiliation":[{"name":"Graduate Program in Quality Management in Health Services (QualiSa\u00fade) Federal University of Rio Grande do Norte\u2013UFRN Natal Rio Grande do Norte Brazil"},{"name":"Department of Infectious Diseases Federal University of Rio Grande do Norte\u2013UFRN Natal Rio Grande do Norte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2214-109x(18)30386-3"},{"key":"e_1_2_11_3_1","volume-title":"Trends in Maternal Mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division","author":"World Health Organization. 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