Avaliação dos cuidados ao parto normal em maternidades públicas de município da região Sul do Brasil
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Data
2019-10-25
Autores
Pinto, Keli Regiane Tomeleri da Fonseca
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A assistência ao parto ainda é permeada por muitas intervenções sem evidências científicas e de maneira rotineira, tornando o cuidado desumanizado e sem qualidade. Diante desse contexto, o objetivo geral desta pesquisa foi analisar a atenção ao parto normal em maternidades de referência para o atendimento ao parto pelo Sistema Único de Saúde, com foco na humanização do cuidado. Trata-se de estudo misto: descritivo e analítico, com amostra quantitativa composta por 344 puérperas e qualitativa, com 25 puérperas que tiveram parto normal em duas maternidades públicas do município de Londrina-Pr. Constituíram fonte de dados: a observação em visita às maternidades; a análise dos prontuários; as Declarações de Nascidos Vivos; as Declarações de Óbitos maternos e as entrevistas com as puérperas. Os dados quantitativos foram processados no Statistical Package for the Social Sciences®, versão 22.0 e para análise dos fatores associados utilizou-se a regressão multivariada de Poisson, considerando p crítico <5%. A medida de efeito utilizada foi a razão de prevalências. Para organização dos resultados qualitativos utilizou-se o referencial metodológico do Discurso do Sujeito Coletivo, sendo os dados discutidos à luz das boas práticas de atenção ao parto. Os resultados dessa pesquisa são apresentados na forma de três manuscritos científicos. O primeiro teve por objetivo analisar a associação entre cuidado recebido durante o trabalho de parto e parto e a qualidade da assistência. A prevalência da qualidade do cuidado percebida pela puérpera durante o trabalho de parto e parto foi de 84,6%. As variáveis, ter tido parto anterior (p=0,039), ter recebido ocitocina (p=0,004) e realização de pré-natal (p=0,019) estiveram estatisticamente associadas à qualidade da assistência, enquanto que o nascimento em local diferente daquele em que ocorreu o trabalho de parto (p=0,002) mostrou-se associado à qualidade inadequada da assistência. O objetivo do segundo manuscrito foi identificar a prevalência e os fatores associados às intervenções obstétricas em parturientes atendidas em maternidades públicas. A prevalência de intervenção obstétrica foi de 55,5% entre as mulheres participantes do estudo. As intervenções mais frequentes foram o uso de ocitocina (50,0%) e a rotura artificial das membranas (29,7%). As variáveis patologia associada (p=0,005) e mecônio intraparto (p=0,022) apresentaram associação significativa com a intervenção obstétrica. O objetivo do terceiro manuscrito foi apreender as experiências e expectativas das puérperas frente aos cuidados recebidos no parto. Após análise emergiram quatro ideias centrais que foram agrupadas em dois temas: 1) Humanização e satisfação com o momento do parto (IC 1 - Estrutura inadequada, mas atendimento satisfatório; IC 2 - O cuidado humanizado e o apoio da equipe); 2) Descontentamento e sofrimento gerados pela assistência durante o parto (IC 3 - Frustração frente à intervenção realizada; IC 4 - Desrespeito e falta de empatia dos profissionais da saúde). Ao avaliar a atenção ao parto normal nas referidas maternidades, pode-se concluir que a assistência desenvolvida apresenta inadequações, pois permanece um elevado número de intervenções e situações de violência obstétrica. As mulheres que foram orientadas durante o processo de parto/nascimento perceberam uma melhor qualidade da assistência, bem como as que foram apoiadas pela equipe de saúde, não tendo relevância os problemas de estrutura física identificados. Ressalta-se que a assistência pode ser melhorada com atitudes simples, de curto prazo e que não requerem investimentos, mas sim sensibilização dos profissionais e o cumprimento do que é preconizado pelas políticas públicas de atenção ao parto, que é o cuidado humanizado baseado em evidências científicas, o respeito à individualidade e aos direitos das mulheres.
The birth care is still permeated by many interventions without scientific evidence and routinely, making care dehumanized and without quality. With this context, the general objective of this research was to analyze the attention to normal birth in reference maternity hospitals for care delivery by the SUS, focusing on humanization of care. This is a mixed study: descriptive and analytical, with a quantitative sample consisting of 344 puerperal and qualitative with 25 puerperal women who had normal birth in two public maternity hospitals in Londrina-Pr. The following were a source of data: observation visiting maternity hospitals; analysis of medical records; the declarations of live births; the declarations of maternal deaths and the interviews with the mothers. Data collection took place in five stages, from January to September 2017. Data were obtained through visiting maternity hospitals; analysis of medical records, declarations of live births and declarations of maternal deaths and by interviews with the mothers. The quantitative data were processed in the Statistical Package for the Social Sciences®, version 22.0 and for the analysis of associated factors, Poisson multivariate regression was used, considering p critical <5%. The measure of effect used was the prevalence ratio. The organize the qualitative results we used the methodological framework of the Collective Subject Discourse, and the data discussed in the light of good childbirth care practices. The results of this research are presented in the form of three scientific manuscripts. The first aimed to analyze the association between care received during labor and delivery and quality of care. The prevalence of quality of care perceived by the postpartum woman during labor and delivery was 84.6%. The variables, having had a previous delivery (p = 0,039), receiving oxytocin (p = 0,004) and prenatal care (p = 0.019) were statistically associated with the quality of care, whereas birth at a different location from that in which labor occurred (p = 0,002) was associated with non-quality of care. The objective of the second manuscript was to identify the prevalence and factors associated with obstetric interventions in parturient attended at public maternity hospitals. The prevalence of obstetric intervention was 55.5% among women participating in the study. The most frequent interventions were the use of oxytocin (50.0%) and artificial rupture of membranes (29.7%). The variables associated pathology (p = 0,005) and intrapartum meconium (p = 0,022) were significantly associated with obstetric intervention. The purpose of the third manuscript was to apprehend the experiences and expectations of the mothers in relation to the care received in childbirth. After analysis four central ideas emerged that were grouped into two themes: 1) Humanization and satisfaction with the moment of delivery (CI 1 - Inadequate structure but satisfactory care; CI 2 - Humanized care and team support); 2) Discontent and suffering generated by care during childbirth (CI 3 - Frustration regarding the intervention performed; CI 4 - Disrespect and lack of empathy of the health professionals). In assessing the attention to normal delivery in these maternity hospitals, it can be concluded that presents inadequacies, because there remains a high number of interventions and situations of obstetric violence. Women who were oriented during the birth / birth process felt satisfied, as well as those supported by the health team, and the identified physical structure problems were not relevant. However, that care assistance can be improved with simple, short-term attitudes that require no investment, but rather awareness of professionals and compliance with what is advocated by public policies of childbirth care, which is evidence-based humanized care, respect for individuality and women's rights.
The birth care is still permeated by many interventions without scientific evidence and routinely, making care dehumanized and without quality. With this context, the general objective of this research was to analyze the attention to normal birth in reference maternity hospitals for care delivery by the SUS, focusing on humanization of care. This is a mixed study: descriptive and analytical, with a quantitative sample consisting of 344 puerperal and qualitative with 25 puerperal women who had normal birth in two public maternity hospitals in Londrina-Pr. The following were a source of data: observation visiting maternity hospitals; analysis of medical records; the declarations of live births; the declarations of maternal deaths and the interviews with the mothers. Data collection took place in five stages, from January to September 2017. Data were obtained through visiting maternity hospitals; analysis of medical records, declarations of live births and declarations of maternal deaths and by interviews with the mothers. The quantitative data were processed in the Statistical Package for the Social Sciences®, version 22.0 and for the analysis of associated factors, Poisson multivariate regression was used, considering p critical <5%. The measure of effect used was the prevalence ratio. The organize the qualitative results we used the methodological framework of the Collective Subject Discourse, and the data discussed in the light of good childbirth care practices. The results of this research are presented in the form of three scientific manuscripts. The first aimed to analyze the association between care received during labor and delivery and quality of care. The prevalence of quality of care perceived by the postpartum woman during labor and delivery was 84.6%. The variables, having had a previous delivery (p = 0,039), receiving oxytocin (p = 0,004) and prenatal care (p = 0.019) were statistically associated with the quality of care, whereas birth at a different location from that in which labor occurred (p = 0,002) was associated with non-quality of care. The objective of the second manuscript was to identify the prevalence and factors associated with obstetric interventions in parturient attended at public maternity hospitals. The prevalence of obstetric intervention was 55.5% among women participating in the study. The most frequent interventions were the use of oxytocin (50.0%) and artificial rupture of membranes (29.7%). The variables associated pathology (p = 0,005) and intrapartum meconium (p = 0,022) were significantly associated with obstetric intervention. The purpose of the third manuscript was to apprehend the experiences and expectations of the mothers in relation to the care received in childbirth. After analysis four central ideas emerged that were grouped into two themes: 1) Humanization and satisfaction with the moment of delivery (CI 1 - Inadequate structure but satisfactory care; CI 2 - Humanized care and team support); 2) Discontent and suffering generated by care during childbirth (CI 3 - Frustration regarding the intervention performed; CI 4 - Disrespect and lack of empathy of the health professionals). In assessing the attention to normal delivery in these maternity hospitals, it can be concluded that presents inadequacies, because there remains a high number of interventions and situations of obstetric violence. Women who were oriented during the birth / birth process felt satisfied, as well as those supported by the health team, and the identified physical structure problems were not relevant. However, that care assistance can be improved with simple, short-term attitudes that require no investment, but rather awareness of professionals and compliance with what is advocated by public policies of childbirth care, which is evidence-based humanized care, respect for individuality and women's rights.
Descrição
Palavras-chave
Saúde Materno-Infantil, Saúde da Mulher, Avaliação em Saúde, Humanização, Parto normal, Maternal and Child Health, Women's Health, Health Assessment, Humanization, Normal Birth, Salud de la mujer, Evaluación de salud, Salud materno-infantil, Humanización,