Parto e nascimento no Brasil: um cenário em processo de mudança

Abstract

Public Health, revealing for the first time an overview of the obstetric and birth care in the country, which is characterized by excessive interventions and even iatrogenic complications for mothers and their infants 1 . The study's findings raised concerns and debates in the academic community, health professionals' associations, social organizations, and in the society at large.A review of the changes that have occurred is necessary, although challenging, knowing that research results alone are unable to produce immediate changes in practices and public policies in obstetric and birth care. Still, to the results are added other ongoing initiatives in the quest to respond to the desires of women, families, policymakers, and health professionals.In 2011, the program known as Stork Network was launched in the Brazilian Unified National Health System (SUS), involving hospitals that serve users of public health services, with the aim of guaranteeing access, solidarity, and quality of obstetric and birth care 2 . A recent independent evaluation of the Stork Network was conducted by academic institutions and showed promising results, with higher rates of good practices and a reduction in unnecessary interventions.Among the educational initiatives, we highlight the the development of a distance education program called Training in Surveillance of Maternal, Infant, and Fetal Deaths for Action by Mortality Committees, developed by our research group in collaboration with the Brazilian Ministry of Health. The course aimed to enhance data recording and information systems in order to improve the care provided to mothers and infants. From 2013 to 2015, 99 tutors and 2,586 students were trained in 891 municipalities of Brazil.In 2015, a program called Adequate Birth was launched aiming primarly at reducing cesarean sections in private services in Brazil. Although initial participation was limited, the program included highly prestigious hospitals in the early stage, which later helped consolidate and expand the initiative, now boasting voluntary participation by nearly 150 hospitals. The program's initial results are also being assessed and have shown improvement in various indicators in these hospitals, such as reductions in cesarean sections and in births at 37-38 weeks' gestational age, referred to as early-term neonates 3 .

The use of the Delphi Method adjusted to evaluate the Stork Network: from Image-objective to Reality

“…The initiatives developed to strengthen the Stork Network program in the Third Macro Region and to aggregate the strategic institutions were irrelevant. Among the articulations 16,17 , it can be observed the ones carried out in an incipient way between the state and municipal administrations (Regional Health Offices and Municipal Health Secretariats), in order to implant and implement the network in an articulated way.…”

“…Therefore, it is opportune to judge the complexity of this initiative, because its results should be able to compel changes in public policies, related to SN, defined by the Ministry of Health (MS), whose responsibility is shared in SUS 10,17,18 .…”

Curso de aprimoramento para enfermeiras obstétricas do Projeto Apice On: relato de experiência

“…2 The program was developed at university and certified teaching hospitals that performed more than 1,000 deliveries between January and December 2015 and adhered to the "Rede Cegonha" strategy, totaling approximately 97 signatory hospitals, distributed in all states of the country and in the Federal District. 2 Together with the Rede Cegonha, Adequate Childbirth, the Maternal, Infant and Fetal Death Surveillance Training Program, among others, the project represented one of the MOH initiatives aimed at changing the Brazilian obstetric scenario, 3 which has been the target of national and international criticism in recent years due to the high rates of childbirth interventions, cesarean section surgery and obstetric violence. 3,4 Thus, the main objective of Apice On was the implementation and the capillarization of practices based on scientific evidence, among them, the insertion of the figure of the obstetric/obstetrician nurse in direct delivery care.…”

Determinants of the offer of breast milk complements for newborns

“…Another worrying factor has been the increased offer of milk formulas due to the shortage of pasteurized breast milk in human milk banks (HMB). This practice, in turn, has been related to the increased risk of intestinal dysbiosis, infections and allergy to the cow's milk protein in NB [14,18]. It is known that breast milk is rich in essential amino acids, growth factors, immunoglobulins, probiotics, among other essential substances for neonatal development.…”