Challenges to the improvement of obstetric care in maternity hospitals of a large Brazilian city: an exploratory qualitative approach on contextual issues

Objetivo: descrever a percepção dos profissionais de saúde acerca dos aspectos relacionados à humanização ao parto e nascimento Metodologia: Estudo descritivo com abordagem qualitativa, realizado com 26 profissionais de saúde especialistas em obstetrícia (10 enfermeiros e 16 médicos) de três maternidades públicas de risco habitual em Recife-PE. Utilizou-se como referencial teórico a Análise crítica do discurso. Resultados: Dificuldades enfrentadas no desenvolvimento da assistência ao parto e nascimento; Discurso divergente em relação à humanização da assistência ao parto e nascimento; Divergência entre modelos assistenciais obstétricos seguidos. Conclusões: percebe-se a necessidade de ampliar a compreensão de humanização do parto e nascimento pelos profissionais, tendo como objetivo prestar uma atenção voltada às necessidades da parturiente e família.Descritores: Humanização da assistência; Assistência ao parto; Parto.INTERFACES BETWEEN HEALT H PRO FESSIONALS AND HUMANIZATION OF LABOR ASSISTANCEObjective: to describe the perception of health professionals about the aspects related to humanization at birth and birth. Methodology: A descriptive study with a qualitative approach, carried out with 26 health professionals specialized in obstetrics (10 nurses and 16 physicians) from three public maternity hospitals at usual risk In Recife-PE. Critical analysis of discourse was used as theoretical reference. Results: Difficulties faced in the development of delivery and birth care; Divergent discourse regarding the humanization of delivery and birth care; Divergence between assisted obstetric care models. Conclusions: the need to extend the understanding of humanization of birth and birth by professionals is perceived, with the objective of paying attention to the needs of the parturient and the family.Descriptors: Humanization of Assistance; Midwifery; Delivery.INTERFACES ENTRE PRO FESIONALES DE SAL UD Y LA HUMANIZACIÓN DE LA ASISTENCIA AL PARTOObjetivo: describir la percepción de los profesionales de salud acerca de los aspectos relacionados con la humanización al parto y el nacimiento. Métodos: Estudio descriptivo con abordaje cualitativo, realizado con 26 profesionales de salud especialistas en obstetricia (10 enfermeros y 16 médicos) de tres maternidades públicas de riesgo habitual En Recife-PE. Se utilizó como referencial teórico el análisis crítico del discurso. Resultados: Dificultades enfrentadas en el desarrollo de la asistencia al parto y el nacimiento; Discurso divergente en relación con la humanización de la asistencia al parto y el nacimiento; Divergencia entre modelos asistenciales obstétricos seguidos. Conclusiones: se percibe la necesidad de ampliar la comprensión de humanización del parto y nacimiento por los profesionales, teniendo como objetivo prestar una atención volcada a las necesidades de la parturienta y familia.Descriptores: Humanización de la Atención; Tocología; Parto Obstétrico.

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The prevalence of the technocratic model in obstetric care from the perspective of health professionals

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2020-0689 ◽

2021 ◽

Vol 74 (suppl 4) ◽

Author(s):

Marli Therezinha Stein Backes ◽

Karini Manhães de Carvalho ◽

Larissa Nascimento Ribeiro ◽

Tamiris Scoz Amorim ◽

Evanguelia Kotzias Atherino dos Santos ◽

...

Keyword(s):

Health Professionals ◽

Scientific Evidence ◽

Obstetric Care ◽

Ethics Committees ◽

Obstetric Nurses ◽

Data Collection And Analysis ◽

Maternity Hospitals ◽

Theoretical Sampling ◽

Centered Care ◽

Nursing Professionals

ABSTRACT Objectives: to identify the reasons for the prevalence of the technocratic model in obstetric care from the perspective of health professionals. Methods: Grounded Theory. Study approved by two Research Ethics Committees and conducted by theoretical sampling, from July 2015 to June 2017. Twenty-nine interviews were conducted with health professionals from two maternity hospitals in the Southern Region of Brazil. Data collection and analysis was performed alternately; and analysis by open, axial, and selective coding/integration. Results: the technocratic model still persists because the assistance is performed in a mechanized way, centered on the professionals. There is a lack of systematization of care, and under-dimensioning of the nursing staff. Final Considerations: obstetric nurses need to review their performance in obstetric centers, the internal organization, the dimensioning of nursing professionals, and become protagonists of care. Investment in academic training/updating the knowledge of midwifery professionals, based on scientific evidence and user-centered care is necessary.

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Incidence and main causes of severe maternal morbidity in São Luís, Maranhão, Brazil: a longitudinal study

Sao Paulo Medical Journal ◽

10.1590/s1516-31802011000300005 ◽

2011 ◽

Vol 129 (3) ◽

pp. 146-152 ◽

Cited By ~ 8

Author(s):

Ana Paula Pierre Moraes ◽

Sandhi Maria Barreto ◽

Valéria Maria Azeredo Passos ◽

Patrícia Silva Golino ◽

Janne Ayre Costa ◽

...

Keyword(s):

Longitudinal Study ◽

Maternal Morbidity ◽

Obstetric Care ◽

Objective Evaluation ◽

Severe Maternal Morbidity ◽

Obstetric Hemorrhage ◽

Prospective Longitudinal Study ◽

Significance Level ◽

Maternity Hospitals ◽

Prospective Longitudinal

CONTEXT AND OBJECTIVE: Evaluation of severe maternal morbidity has been used in monitoring of maternal health. The objective of this study was to estimate its incidence and main causes in São Luís, Maranhão, Brazil. DESIGN AND SETTING: Prospective longitudinal study, carried out in two public high-risk maternity hospitals and two public intensive care units (ICUs) for referral of obstetric cases from the municipality. METHODS: Between March 1, 2009, and February 28, 2010, all cases of severe maternal morbidity according to the Mantel and Waterstone criteria were identified. The sociodemographic and healthcare characteristics of the extremely severe cases were compared with the less severe cases, using the Fisher, Χ2, Student t and Mann-Whitney tests, with a significance level of < 0.05. RESULTS: 127 cases of severe maternal morbidity were identified among 8,493 deliveries, i.e. an incidence of 15.0/1000 deliveries. Out of 122 cases interviewed, 121 cases were within the Waterstone criteria and 29 were within the Mantel criteria, corresponding to incidences of 14.1/1000 and 3.4/1000 deliveries, respectively. These rates were lower than those described in the literature, possibly due to case loss. The main causes were hypertension during pregnancy, which was more frequent in less severe cases (P = 0.001) and obstetric hemorrhage, which was more common among extremely severe cases (P = 0.01). CONCLUSIONS: Direct obstetric disorders were the main causes of severe maternal morbidity in São Luís, Maranhão. Investigation and monitoring of severe morbidity may contribute towards improving obstetric care in the municipality.

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Humanized childbirth: the values of health professionals in daily obstetric care

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2021-0052 ◽

2022 ◽

Vol 75 (2) ◽

Author(s):

Diego Pereira Rodrigues ◽

Valdecyr Herdy Alves ◽

Cristiane Cardoso de Paula ◽

Bianca Dargam Gomes Vieira ◽

Audrey Vidal Pereira ◽

...

Keyword(s):

Health Professionals ◽

Phenomenological Study ◽

Obstetric Care ◽

Metropolitan Region ◽

Care Process ◽

Methodological Framework ◽

Physiological Processes ◽

Maternity Hospitals ◽

Phenomenological Interview ◽

Region Ii

ABSTRACT Objective: To understand health professionals' values in the process of thinking and feeling about obstetric care, based on their experienced needs in the care process. Methods: Phenomenological study based on the Schelerian framework, with 48 health professionals from four maternity hospitals within the Metropolitan Region II of the state of Rio de Janeiro. Data collection was done through a phenomenological interview; and the analysis, with the Ricoeurian methodological framework. Results: The vital value was signified in care centered on physiological processes, for an individualized and safe monitoring. The ethical value was signified in the attitudes that provide women with autonomy in their way of giving birth, and recognize dialogue as a process of sympathy, affection, and bonding. Conclusion: The resignification of obstetric practice, articulated with public policies in the field of delivery and birth, supported by a vital ethical value, positively contributes to the humanization of care for women.

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Adverse obstetric outcomes in two Brazilian maternity hospitals

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-02-2020-0026 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Alessa Leila Andrade ◽

Zenewton André da Silva Gama ◽

Marise Reis de Freitas ◽

Wilton Rodrigues Medeiros ◽

Kelienny de Meneses Sousa ◽

...

Keyword(s):

Patient Safety ◽

High Risk ◽

Adverse Outcome ◽

Obstetric Care ◽

Care Quality ◽

Adverse Outcomes ◽

Content Type ◽

Maternity Hospitals ◽

One Year

PurposeObstetric adverse outcomes (AOs) are an important topic and the use of composite measures may favor the understanding of their impact on patient safety. The aim of the present study was to estimate AO frequency and obstetric care quality in low and high-risk maternity hospitals.Design/methodology/approachA one-year longitudinal follow-up study in two public Brazilian maternity hospitals. The frequency of AOs was measured in 2,880 randomly selected subjects, 1,440 in each institution, consisting of women and their newborn babies. The frequency of 14 AOs was estimated every two weeks for one year, as well as three obstetric care quality indices based on their frequency and severity as follows: the Adverse Outcome Index (AOI), the Weighted Adverse Outcome Score and the Severity Index.FindingsA significant number of mothers and newborns exhibited AOs. The most prevalent maternal AOs were admission to the ICU and postpartum hysterectomy. Regarding newborns, hospitalization for > seven days and neonatal infection were the most common complications. Adverse outcomes were more frequent at the high-risk maternity, however, they were more severe at the low-risk facility. The AOI was stable at the high-risk center but declined after interventions during the follow-up year.Originality/valueHigh AO frequency was identified in both mothers and newborns. The results demonstrate the need for public patient safety policies for low-risk maternity hospitals, where AOs were less frequent but more severe.

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OBSTETRIC VIOLENCE AND THE CURRENT OBSTETRIC MODEL, IN THE PERCEPTION OF HEALTH MANAGERS

Texto & Contexto - Enfermagem ◽

10.1590/1980-265x-tce-2019-0248 ◽

2020 ◽

Vol 29 ◽

Author(s):

Enimar de Paula ◽

Valdecyr Herdy Alves ◽

Diego Pereira Rodrigues ◽

Felipe de Castro Felicio ◽

Renata Corrêa Bezerra de Araújo ◽

...

Keyword(s):

Rio De Janeiro ◽

Scientific Evidence ◽

Quality Care ◽

Obstetric Care ◽

The State ◽

Metropolitan Region ◽

Obstetric Violence ◽

Maternity Hospitals ◽

Region Ii ◽

Health Managers

ABSTRACT Objectives: to understand the perception of managers of public maternity hospitals in the Metropolitan Region II of the state of Rio de Janeiro regarding obstetric violence and the measures to face it aiming at guaranteeing the quality of care. Method: a descriptive, exploratory study with a qualitative approach, conducted with 16 health managers from five maternity hospitals in Metropolitan Region II in the state of Rio de Janeiro. Data were collected through interviews, applied from May 2017 to May 2018, and submitted to content analysis in the thematic modality. Results: the research pointed out thenon-reception, technocratic principles of childbirth, refusal of the companion, disrespect to humanized practices centered on physiology and the choice of women, the need for health training as a guide for the humanization policy and the management of health units, professional unpreparedness for performance and lack of involvement of professionals with longer service time to modify practices in obstetric care. Thus, the need to break away from obstetric violence at the structural/institutional level was evident in order to guarantee quality care for women. Conclusion: it is the responsibility of the managers to provide training to health professionals regarding performance that respects the scientific evidence, the centrality and the axes of policies and recommendations in the area of sexual and reproductive health, especially to women regarding their autonomy.

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Using the Bologna Score to assess normal delivery healthcare

Revista da Escola de Enfermagem da USP ◽

10.1590/s0080-623420160000600005 ◽

2016 ◽

Vol 50 (5) ◽

pp. 741-748 ◽

Cited By ~ 2

Author(s):

Isaiane da Silva Carvalho ◽

Rosineide Santana de Brito

Keyword(s):

Obstetric Care ◽

Cross Sectional Study ◽

Northeastern Brazil ◽

Sectional Study ◽

Cross Sectional ◽

Normal Delivery ◽

Spontaneous Vaginal Delivery ◽

Maternity Hospitals ◽

The City ◽

Primiparous Women

Abstract OBJECTIVE Describing the obstetric care provided in public maternity hospitals during normal labour using the Bologna Score in the city of Natal, Northeastern Brazil. METHOD A quantitative cross-sectional study conducted with 314 puerperal women. Data collection was carried out consecutively during the months of March to July 2014. RESULTS Prenatal care was provided to 95.9% of the mothers, beginning around the 1st trimester of pregnancy (72.3%) and having seven or more consultations (51%). Spontaneous vaginal delivery was planned for 88.2% women. All laboring women were assisted by a health professional, mostly by a physician (80.6%), and none of them obtained 5 points on the Bologna Score due to the small percentage of births in non-supine position (0.3%) and absence of a partogram (2.2%). A higher number of episiotomies were observed among primiparous women (75.5%). CONCLUSION The score obtained using the Bologna Index was low. Thus, it is necessary to improve and readjust the existing obstetrical model.

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Coexistence and prevalence of obstetric interventions: an analysis based on the grade of membership

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04092-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Karina Cristina Rouwe de Souza ◽

Thales Philipe Rodrigues da Silva ◽

Ana Kelve de Castro Damasceno ◽

Bruna Figueiredo Manzo ◽

Kleyde Ventura de Souza ◽

...

Keyword(s):

Pain Relief ◽

Skin Color ◽

Scientific Evidence ◽

Obstetric Care ◽

World Health ◽

Cross Sectional ◽

Maternity Hospitals ◽

Oxytocin Infusion ◽

Grade Of Membership ◽

Belo Horizonte

Abstract Background Obstetric interventions performed during delivery do not reflect improvements in obstetric care. Several practices routinely performed during childbirth, without any scientific evidence or basis - such as Kristeller maneuver, routine episiotomy, and movement or feeding restriction - reflect a disrespectful assistance reality that, unfortunately, remains in place in Brazil. The aims of the current study are to assess the coexistence and prevalence of obstetric interventions in maternity hospitals in Belo Horizonte City, based on the Grade of Membership (GoM) method, as well as to investigate sociodemographic and obstetric factors associated with coexistence profiles generated by it. Methods Observational study, based on a cross-sectional design, carried out with data deriving from the study “Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento” (Born in Belo Horizonte: Survey on Childbirth and Birth). The herein investigated interventions comprised practices that are clearly useful and should be encouraged; practices that are clearly harmful or ineffective and should be eliminated; and practices that are inappropriately used, in contrast to the ones recommended by the World Health Organization. The analyzed interventions comprised: providing food to parturient women, allowing them to have freedom to move, use of partogram, adopting non-pharmacological methods for pain relief, enema, perineal shaving, lying patients down for delivery, Kristeller maneuver, amniotomy, oxytocin infusion, analgesia and episiotomy. The current study has used GoM to identify the coexistence of the adopted obstetric interventions. Variables such as age, schooling, skin color, primigravida, place-of–delivery financing, number of prenatal consultations, gestational age at delivery, presence of obstetric nurse at delivery time, paid work and presence of companion during delivery were taken into consideration at the time to build patients’ profile. Results Results have highlighted two antagonistic obstetric profiles, namely: profile 1 comprised parturient women who were offered diet, freedom to move, use of partogram, using non-pharmacological methods for pain relief, giving birth in lying position, patients who were not subjected to Kristeller maneuver, episiotomy or amniotomy, women did not receive oxytocin infusion, and analgesia using. Profile 2, in its turn, comprised parturient women who were not offered diet, who were not allowed to have freedom to move, as well as who did not use the partograph or who were subjected to non-pharmacological methods for pain relief. They were subjected to enema, perineal shaving, Kristeller maneuver, amniotomy and oxytocin infusion. In addition, they underwent analgesia and episiotomy. This outcome emphasizes the persistence of an obstetric care model that is not based on scientific evidence. Based on the analysis of factors that influenced the coexistence of obstetric interventions, the presence of obstetric nurses in the healthcare practice has reduced the likelihood of parturient women to belong to profile 2. In addition, childbirth events that took place in public institutions have reduced the likelihood of parturient women to belong to profile 2. Conclusion(s) Based on the analysis of factors that influenced the coexistence of obstetric interventions, financing the hospital for childbirth has increased the likelihood of parturient women to belong to profile 2. However, the likelihood of parturient women to belong to profile 2 has decreased when hospitals had an active obstetric nurse at the delivery room. The current study has contributed to discussions about obstetric interventions, as well as to improve childbirth assistance models. In addition, it has emphasized the need of developing strategies focused on adherence to, and implementation of, assistance models based on scientific evidence.

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OVERVIEW OF IMMEDIATE NEW-BORN CHECK-UP

International Journal of Research in Medical Sciences & Technology ◽

10.37648/ijrmst.v11i02.015 ◽

2021 ◽

Vol 12 (02) ◽

Author(s):

Muthanna Kanaan Zaki ◽

Muthanna Kanaan Zaki

Keyword(s):

Obstetric Care ◽

Infant Care ◽

Maternity Hospital ◽

Control Group ◽

Newborn Resuscitation ◽

New Born ◽

Basic Care ◽

Maternity Hospitals ◽

Available Information ◽

The Impact

There's proof from maternity hospital-based settings in developing countries that newborn resuscitation education of the staff diminishes new-born deaths from inborn associated events, such as neonatal asphyxia (by 30%), with potential saving 93,700 neonates globally per year by investigating missed attendance of birth clinics or maternity hospitals, together with (up to 192,000) new-born at 90% scope, as it was considering the impact on intrapartum-related neonatal passings. In an arrangement to realize a higher reduction in intrapartum-related newborn passing's, preterm delivery and intrapartum death, a compelling obstetric plan is considered as the most vital intercession and this ought to be complemented with prompt infant care and resuscitation. There is expanding venture in obstetric care, yet to be coordinated by viable execution and supportability of quick infant care and essential newborn resuscitation. Within the private settings, prompt basic care at birth is essential and accessible, even though evaluated by specialists to be of low effects (10% on before delivery and on stillbirths associated with newborn passings). private hospital settingsbased newborn revival may minimise all the reasons of newborn and before delivery deaths, but available information is critical and controversial to directly gauge an effect size from the prove. Future researches ought to endeavour to address impediments distinguished here especially in terms of intercession definitions, plan, comparative control group, outcome identification and subdivision of reasons of stillbirths and neonatal passings. Whereas the available types of evidence for incitement at delivery and neonatal revival are low, mostly since they are regarded as a plan of care, there is adequate and consistent prove of effect. However, such fundamental care stays irregular particularly for the global 60 million home births. Disentangled preparing plan, and effective protocol, low price hardware are presently ac

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NEONATOLOGISTS AT THE OBSTETRIC ORGANIZATIONS OF MEGAPOLIS: OCCUPATIONAL ACTIVITY AND ATTITUDE TO THE OCCUPATION

Российский педиатрический журнал ◽

10.18821/1560-9561-2019-22-6-366-372 ◽

2019 ◽

Vol 22 (6) ◽

pp. 366-372

Author(s):

Karina E. Moiseeva

Keyword(s):

Financial Support ◽

Obstetric Care ◽

Working Hours ◽

Medical Specialty ◽

Occupational Activity ◽

Labor Intensity ◽

Medical Work ◽

Educational Work ◽

Maternity Hospitals

Materials and methods. An anonymous survey of 146 neonatologists working in obstetric organizations in the city St. Petersburg was conducted. Mathematical data processing was carried out using spreadsheets “MS Office Excel 2010” and the statistical software package PASW STATISTICS. Results. 36.4% of neonatologists working in obstetric organizations believe the occupational standard “Neonatologist” fails to fully reflect all their duties. Neonatologists call the functions associated with the implementation of medical work to be the most important labor functions included in the Occupational Standard, sanitary and educational work and activities related to the maintenance of accounting and medical records are believed to be the least important. 29.1% of neonatologists of obstetric care organizations work for more than one rate, 28.6% of doctors do not work on schedule, 58.4% have a feeling of overwork. Conclusions. Despite the fact that most neonatologists have chosen their occupation by vocation and because of love for children, more than half of the doctors are partially or completely disappointed with their work, most often due to unsatisfactory working conditions and its financial support. High workload and labor intensity, observed by almost 30% of neonatologists, can lead to an increase in the risk of medical error and a decrease in the quality of medical care. 51.7% of doctors are partially or completely unsatisfied with their work. The main reasons for the dissatisfaction of neonatologists are significant physical and psychological stress (36.6%) and low wages (34.4%). Neonatologists working in maternity hospitals (departments) are 26.8% less likely than doctors at neonatologists at perinatal centers to work at the same rate and 57.1% less often than during working hours but have a higher labor intensity during the working day. Neonatologist working in perinatal centers, to a greater extent than doctors in maternity hospitals (departments), are not satisfied with the conditions and financial support of their activities and are 24.1% more likely to perform occupational duties that are not part of the professional standard “Neonatologist”. Most neonatologists working in obstetric organizations have chosen their profession by calling (58.5%) and because of their love for children (62.8%), they fully feel responsible for the quality of their work (99.3%), they do not want to change their medical specialty (93.5%) and are satisfied with the choice of occupation (93.3%).

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