Dois olhares na assistencia humanizada ao parto : vivencia de mulheres e opinião de profissionais de saude

AUTOR(ES)
DATA DE PUBLICAÇÃO

2005

RESUMO

This project was composed by two descriptive studies of the routines proposed for the humanization of care during childbirth recommended by the Ministry of Health, and implemented at an university maternity starting in 2001. The goal was to evaluate opinions and perceptions of women and professionals on these new routines, contrasting their views. At the first study, we evaluated women?s experiences and opinions on the new routines, and the quality of care. The sample comprised 292 post-partum women supposing 50% would not be satisfied with care received. Women were interviewed between the 1st and 3rd post partum day, between Nov/03 to Feb/04. Only women in spontaneous labor were admitted. Average age and parity were 23.8 years and 1.8 children respectively, with 45.6% with minimal secondary level of schooling, 80% having no professional activity, 90% living with a partner. Around 40% had antenatal care at the institution. Almost 80% had vaginal deliveries, with 49.7% receiving episiotomy, and half submitted to epidural analgesia. Pain was relieved by hot shower, and massage for one?third. At admission, 69.2% received a supra-pubic narrow-band shaving. Nevertheless, most of the women reported they would have complete shave next time due hygiene reasons, to facilitate procedures, and the baby been delivered. Only one received enema, but 34.6% would expect one next time. Half of them had a companion, mother or partner, a good experience for 94.4%. The other half would like to have had one. Mother-baby contact at the delivery room occurred in 94.2%. Three-fourth considered having received a humane attention during delivery, 85.5% were satisfied or very satisfied, and 95.5% would recommend CAISM for childbirth. At the second study, we compare knowledge, attitudes and practices among faculties, residents and nurses on the new routines for a humanized childbirth. An anonymous self-responded questionnaire was handed to 55 professionals working at the delivery room at that time (17 faculties or assistant-physicians, 30 residents, and 8 nurses, between Jan-Feb 2004. Response rates were 76% among faculties, 40% among residents, and 87.5% among nurses, and female predominate (71%). All professionals observed there was a new routine to care during labor and delivery. Nevertheless, nurses agreed with new practices implementation in higher percentage, followed by faculties. Some residents question the abolition of shaving, and enema, and the difficulties to access epidural analgesia for all who are perceived to need a stronger pain relief. Professionals agreed to the introduction of the new routines proposed by the Ministry of Health, and with the classification of practices proposed, and are following the vast majority of recommendations. Some discrepancies between users and professionals on the proportion who perceived new routines as massage and selective episiotomy. The users study concluded they received a humanized care during childbirth, and the implementation of these routines was achievable into an university reference-maternity, remaining the need to improve certain aspects as the access to epidural for pain relief if needed and the percentage of women with hers choice companion. Professionals adopted, accepted and followed the new routines at the reference public university maternity, with a reasonable concordance with the Ministry of Health classification of practices. Discrepancies in perception for a few new practices may represent the differential responsibility in a shared care planning. Contrasting the views of users and professionals, we can observe that the last group I more critical, considering the quality of care sub-optimal, The reasons raised for their opinion include lack of training on pain relief, diverging decisions, and lack of privacy. Nevertheless, these facts were not high valued by users. Among them, the affective-emotional support was the essential component of a high level of satisfaction with care received. We concluded that it is important to have both views to qualify care. As far as possible, demands from both should be addressed, keeping the principle of benefit without harm, and protagonism of the women delivering, in an essential moment their affective-reproductive life cycle

ASSUNTO(S)

medicina baseada em evidencias humanização do parto qualidade dos cuidados de saude

ACESSO AO ARTIGO

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