Structure and practices in hospitals of the Apice ON Project: a baseline study

Abstract

OBJECTIVE: To describe some characteristics of the 97 teaching hospitals participating in the Projeto de Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia (Apice ON— Project for Improvement and Innovation in Care and Teaching in Obstetrics and Neonatology). METHODS: The semester prior to the beginning of the program was adopted as the baseline to evaluate the subsequent structural and processes changes of this project. Secondary data from the first half of 2017 were extracted from the National Registry of Health Establishments (NRHE), the Hospital Information System and the Sistema de Informações sobre Nascidos Vivos (SINASC—Live Birth Information System). RESULTS: Before the implementation of the project, only 66% of the hospitals had a Babyfriendly Hospital Initiative, only 3% offered special accommodations for high-risk pregnant women, mothers and their newborns, and 45.4% hospitals adopted the skin-to-skin contact; 97% hospitals had separate rooms for pre-labor and vaginal delivery (93%), not following the recommendations of the Ministry of Health; nine hospitals (9%) had no rooming-in; there were few obstetrics nurses (less than 1% of professionals enrolled in the NRHE), and in only six hospitals the proportion of births assisted by this professional was above 50% of vaginal deliveries, while in eight this percentage ranged between 15% and 50%; the average cesarean section rate was 42%, ranging between 37.6% (Southeast) and 49.1% (Northeast); ten hospitals did not charge for companions according to inpatient hospital authorization. CONCLUSION: The study strengthens the relevance of the Apice ON project as an inducer of change of the care model in teaching hospitals and, therefore, as a strategy for the implementation of the national public policy represented by the Stork Network.

Cesarean sections in Brazil’s teaching hospitals: an analysis using Robson Classification

“…This baseline study innovates by proposing that interventionist approaches in obstetrics might be derived from the way obstetrics is taught. A previous article on the same TH described how an important proportion of them do not follow the Brazilian Ministry of Health guidelines, some of which even stem from the 1980s, such as rooming-in, or from the 1990s, such as the international Baby-Friendly Hospital Initiative (28). This paper showed that these TH do not follow obstetric indications for surgical procedures, adding to the question on how obstetrics is being taught and what kind of professionals will come out from this educational process.…”

Childbirth experience of women in a maternity hospital signatory of the Adequate Childbirth Project: mixed study

“…In this regard, some authors (18) , reflect that technology and its powers of persuasion have reinforced socioculturally that pregnancy, childbirth and delivery are unsafe and pathological events, and the need for medical intervention would be a way of guaranteeing security for these processes.…”

“…Thus, in order for insecurities to be re-signified and the care models such as those of the PPA to be recognized as better by women, it is necessary to uproot the centrality of the medical figure as the sole holder of power and to lead, in a shared way, the singular care, coming from multiprofessional teams, in which information and awareness for choosing the route of childbirth and the cares performed transcend the stereotypes of power created by society (1,(14)(15)18) .…”

O ensino teórico-prático em Enfermagem na saúde da mulher: um relato de experiência

“…A história da instituição, cenário do ensino teórico-prático, permite compreender e visualizar as articulações das diferentes instâncias públicas (Federal, Estadual e Municipal), uma vez que estão presentes na administração e execução dos serviços de saúde oferecidos à população de Niterói/RJ. (Apiceon, 2017) Saúde e da Educação a elaborar uma proposta de mudança no modelo de atenção vigente: o projeto APICEON, instituído numa rede de hospitais com atividades de ensino para contribuir com a implementação e disseminação de boas práticas, promovendo mudanças nos modelos tradicionais de formação, atenção e gestão (Mendes & Rattner, 2020).…”