Table 2 Main words, type of contribution, opinion and excerpts per class - classes 1 to 5

 Main Words

TS in the class

X²

Contributor and opinion

Illustrative excerpt 1 - Absolute score

297.86

Illustrative excerpt 2 - Absolute score

269.35

Illustrative excerpt 3 - Absolute score

254.81

Illustrative excerpt 4 - Absolute score

222.17

Illustrative excerpt 5 - Absolute score

215.72

 complication

42

97.67

family member,

caregiver, health_professional

highly_inadequate

inadequate

fair

“childbirth should be performed by an obstetrician in a hospital setting to ensure the safety of mother and baby. Barriers for implementation are complications arising with no doctor to take responsibility”

“an obstetrician should always be present during childbirth. Barriers to implementation are that even uncomplicated births should always take place in a hospital setting with a team that is qualified to deal with any complication that might arise”

“obstetric nurses and midwives cannot take responsibility for complications during childbirth and there should always be an obstetrician present responsible for monitoring labor because complications are usually unexpected and require immediate medical attention”

“but suggesting that these people are more qualified than doctors or that young mothers who could give birth in a properly equipped setting should be subjected to risks and complications that cannot be dealt with at home by a legally accountable professional is absurd. Who will take legal responsibility for the consequences to mother and child if the necessary measures are not taken in the event of a complication?”

“because only doctors have the necessary technical training to deal with possible complications that might arise even in normal or uncomplicated births”

 medical_obstetrician

59

70.24

 no

134

52.55

 mother

31

81.58

 childbirth

107

53.23

 see

24

85.71

 risck

33

73.33

 hospital_setting

21

87.5

 stay

17

94.44

 study

21

80.77

 possible

22

78.57

 even

35

66.04

 pediatrician

13

92.86

 complications

14

87.5

 patient

37

61.67

 Main Words

TS in the class

X²

Contributor and opinion

Illustrative excerpt 1 - Absolute score

1103.04

Illustrative excerpt 2 - Absolute score

1082.77

Illustrative excerpt 3 - Absolute score

1050.61

Illustrative excerpt 4 - Absolute score

1043.00

Illustrative excerpt 5 - Absolute score

1027.64

 implementation

264

323.74

Patient

Very good

“barriers for implementation include resistance from the federal government and facilitators are training health professionals who provide care during childbirth especially doctors who largely follow a protocol of cesarean section deliveries and unnecessary interventions”

“barriers for implementation are the structure of the health system and the professionals involved as well as the lack of humanized care and facilitators are training and changing medical and hospital protocols”

“barriers for implementation include the poor facilities at hospitals, the lack of human resources and materials as well as an overburdened national health system. Facilitators are awareness among health professionals and greater collaboration from management”

“barriers for implementation are resistance to change on the part of health professionals lack of financial support for maternity hospitals and the municipal care model and facilitators include increasing professional training particularly obstetric nurses”

“barriers for implementation include political disinterest and facilitators are training dissemination and awareness among patients, family members and health professionals about the need for change”

 barrier

193

299.63

 facilitator

160

186.21

 lack

70

95.83

 resistance

28

58.84

 professional

103

43.61

 doctor

66

39.37

 willing

16

31.6

 institution

17

30.34

 policy

13

28.8

 national_health_system

19

28.67

 care

27

26.96

 nurse

25

25.09

 training

14

23.78

 offer

15

22.97

 Main Words

TS in the class

X²

Contributor and opinion

Illustrative excerpt 1 - Absolute score

271.88

Illustrative excerpt 2 - Absolute score

243.52

Illustrative excerpt 3 - Absolute score

204.00

Illustrative excerpt 4 - Absolute score

202.82

Illustrative excerpt 5 - Absolute score

181.88

 scientific_evidence

22

54.9

patient

other

patient_groups_organizations_or_associations

Very good

“caring for women during and after childbirth identifying high-risk cases and referring when needed our inclusion is vital to reduce maternal and infant mortality rates in the country as well as unnecessary cesarean deliveries and better informing the population to achieve optimum results”

“facilitators for implementation include open discussions for the community about best practices based on current scientific evidence to raise awareness in multidisciplinary teams regarding care during childbirth”

“barriers for implementation include the current culture of providing obstetric care that blatantly disregards and disrespects the latest scientific evidence in the field”

“I think it’s vital that health professionals are always up to date and trained based on scientific evidence communicating with patients and their families”

“there is no established protocol each professional does what they feel they have learned regardless of scientific evidence training human resources based on the best scientific evidence in the field”

 culture

9

43.39

 based

11

43.09

 general

8

42.09

 community

5

35.2

 social

8

32.59

 population

15

32.13

 health

15

29.01

 good

11

28.91

 health_units

4

28.13

 residence

4

28.13

 extreme

4

28.13

 education

4

28.13

 empowerment

4

28.13

 women’s_health

5

27.71

 Main Words

TS in the class

X²

Contributor and opinion

Illustrative excerpt 1 - Absolute score

983.99

Illustrative excerpt 2 - Absolute score

725.68

Illustrative excerpt 3 - Absolute score

717.03

Illustrative excerpt 4 - Absolute score

697.51

Illustrative excerpt 5 - Absolute score

604.55

 labor

58

152.28

stakeholder

company

Good

“item 105 page 230 if the active the stage of is not progressing the atmosphere in the delivery room should be considered and the wishes of the mother respected”

“we understand that pain relief during childbirth when needed and properly applied can favor labor progression and a healthy vaginal birth contributing to reducing unnecessary and harmful interventions such as cesarean sections”

“there is also a need to improve training given reports of professionals administering pain relief in a way that prevents the mother from moving and compromises”

“this prevents the argument that women should undergo elective cesarean sections to prevent insufficient care during childbirth if they go into labor at home and on days when healthcare teams may not be at optimal”

“we feel that every woman has the right to know and understand the physiological progression of labor as well as the risks and possible benefits of interventions during the process”

 progress

21

124.19

 women

77

118.82

 progression

17

92.77

 relate

13

76.3

 lack

15

63.62

 pain

13

62.78

 want

13

62.78

 right

32

62.2

 pharmacological

10

58.53

 suspect

12

57

 pain_relief_childbirth

20

54.46

 relief

9

52.63

 diagnosis

9

52.63

 respect

20

51.92

 Main Words

TS in the class

X²

Contributor and opinion

Illustrative excerpt 1 - Absolute score

2128.05

Illustrative excerpt 2 - Absolute score

2060.41

Illustrative excerpt 3 - Absolute score

1429.79

Trecho ilustrativo 4 - Escore absoluto 1429.43

Illustrative excerpt 5 - Absolute score

1171.47

 scope

22

389

other

stakeholder

very good

good

“the research group: maternity_women_and_child_health_uff_cnpq feels that implementing these guidelines will help ensure that the labor and delivery process is an instrument for strengthening sexual and reproductive rights within the health policies of the public and private health systems”

“csm_cofen feels that implementing these guidelines will help ensure that the labor and delivery process is an instrument for strengthening sexual and reproductive rights within the health policies of the public and private health systems”

“we feel that adopting this care model will not require significant structural changes to the Brazilian health system and that similar initiatives exist within the Stork Network”

“promote the guidelines as a guiding instrument for childbirth within public and private health services and include them at state and municipal level”

“we feel that the process of compiling national guidelines based on broad debate and the involvement of different stakeholders favors a democratic society and more equitable better-quality care”

 understand

26

262.59

 research group_maternity_women_and_child_health_uff_cnpq

9

157.21

 instrument

11

146.94

 initiative

11

146.94

 state

11

146.94

 described

10

142.62

 municipal

11

135.81

 implementation

15

134.69

 large

17

121.71

 chart

7

105.13

 Brazilian_health_system

6

104.51

 require

6

104.51

 protection

6

104.51

 structural

6

104.51