Comparing Brazilian Guidelines for Normal Birth Care to Other National and International Guidelines.

Objective: To compare the Brazilian national guidelines for normal birth care to guidelines from the National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) on levels of evidence, quality, and applicability for the prevention of maternal mortality.

Design: A review and evaluation of guidelines was conducted using the Appraisal of Guidelines for Research & Evaluation II instrument translated and validated for Brazilian Portuguese.

Setting: Guidelines were selected using criteria such as national or international use and interest, scope, and whether they were a source for other clinical guidelines. Three guidelines and supporting documents related to the guidelines' development were included in the review and evaluation.

Methods: Data were narratively synthesized under four dimensions: (a) quality and applicability of the guidelines, (b) score of each domain in the guidelines, (c) interrater agreement index, and (d) evidence on the consideration of risk and prevention of maternal mortality.

Results: The Brazilian guidelines presented weaknesses in two domains: (a) Accuracy in Development and (b) Applicability. The overall evaluation of the Brazilian guidelines had a rating of 33%, which is lower than the rating for the NICE and WHO guidelines. These scores reflect limitations in systematic evidence gathering, the transparency of recommendations, and the lack of tools and guidance for practical implementation.

Conclusion: The Brazilian guidelines should be reformulated following a process of appropriate planning and development that aligns with international standards.