Intervenções obstétricas durante o trabalho de parto e parto em mulheres brasileiras de risco habitual

Abstract

Este artigo avaliou o uso das boas práticas (alimentação, deambulação, uso de métodos não farmacológicos para alívio da dor e de partograma) e de intervenções obstétricas na assistência ao trabalho de parto e parto de mulheres de risco obstétrico habitual. Foram utilizados dados da pesquisa Nascer no Brasil, estudo de base hospitalar realizada em 2011/2012, com entrevistas de 23.894 mulheres. As boas práticas durante o trabalho de parto ocorreram em menos de 50% das mulheres, sendo menos frequentes nas regiões Norte, Nordeste e Centro-oeste. O uso de ocitocina e amniotomia foi de 40%, sendo maior no setor público e nas mulheres com menor escolaridade. A manobra de Kristeller, episiotomia e litotomia foram utilizada, em 37%, 56% e 92% das mulheres, respectivamente. A cesariana foi menos frequente nas usuárias do setor público, não brancas, com menor escolaridade e multíparas. Para melhorar a saúde de mães e crianças e promover a qualidade de vida, o Sistema Único de Saúde (SUS) e, sobretudo o setor privado, necessitam mudar o modelo de atenção obstétrica promovendo um cuidado baseado em evidências científicas.

Enfermagem obstétrica: contribuições às metas dos Objetivos de Desenvolvimento do Milênio

“…However, during birth, despite the benefits of upright positions for the woman and the fetus, the lithotomy or semi seated position was prevalent, reaching over 88% of births, lower than what was found in a national study (5) ( 91.7%). When comparing the vertical position or side position to the lithotomic position important aspects are highlighted, such as: the reduction of intense soreness and fatigue of women, the reduction of the expulsion stage, besides the reduction of directed delivery rates, episiotomy and obstetric interventions (15) .…”

“…However, these initiatives have proven to be insufficient. It is believed that the persistence of poor maternal and perinatal indicators are directly related to the inappropriate use of technologies or unnecessary interventions, a fact clearly illustrated by the significant current cesarean rate (5) .…”

Why do women in the private sector have shorter pregnancies in Brazil? Left shift of gestational age, caesarean section and inversion of the expected disparity

“…To overcome the present situation of stagnation in maternal and perinatal health indicators, particularly on the early neonatal component and the increase in preterm births, the main challenge in Brazil is changing the institutional culture toward an evidence based care, guided by human rights, sexual and reproductive health rights for woman 9 .…”

“…Every year, babies are increasingly being born in late preterm and early term when compared with the previous years. This phenomenon affects all age, income and education groups, although in Brazil it is more pronounced among more educated women which have higher income, is more frequent in private sector users, where the practice of elective caesarean section is the rule 8,9 .…”

“…There is international recognition that not only the caesarean section (CS), as well as the labour induction, increase the occurrence of Preterm and Early term delivery, with a decrease of Full term and Late term birth 7 . But little information on this intervention is available, especially because of the diffi culty in separating those cases of inductions of those where oxytocin or other drugs are used for augmenting labor, a widespread and poorly reported practice 9 .…”